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PubMed1993

Layer thickness in panoramic radiography as defined by different noise-equivalent passbands.

The layer thickness in rotational panoramic radiography is presented with the use of the concept of the noise-equivalent passband. Conventionally, the layer thickness has been calculated only from one-dimensional data in the horizontal or rotational dimension of panoramic radiography. In the present study, results from calculations using both one- and two-dimensional data are presented. When the vertical dimension is included in the calculations, the layer is wider than when calculated from data in the horizontal dimension only. It is pointed out that the wider layer that follows from the introduction of the vertical dimension may be the most reliable measure of layer thickness in panoramic radiography.

Bone Density↗
PubMed1993

Visualization of basal pleural space and lung with advanced multiple beam equalization radiography (AMBER).

During clinical use of AMBER (Advanced Multiple Beam Equalization Radiography) it was frequently felt that the basal lung and pleural space were better appreciated than with standard chest radiography. We aimed to quantify the amount of additional relevant anatomy seen in this part region and to review the normal radiographic anatomy. Four hundred patients without known chest disease were evaluated. Two groups of 200 patients (50% female) were studied with either AMBER or standard chest radiography (140 kVp, 180 cm FFD, Kodak Tmat G film, Lanex regular screen; for both techniques). Visualization of the pleural sinuses (in percent of the transverse thoracic diameter) and the basal pulmonary vessels (4-point scale) was evaluated by a panel of 3 radiologists. The shape of the sinus was traced if sufficiently visible and subjectively evaluated. A significantly (P < 0.05) larger segment of the dorsal (41 +/- 34%) and ventral (14 +/- 15%) sinuses was seen with the AMBER technique than with the standard technique (16 +/- 21% and 9 +/- 11%, respectively). Vessel visibility was also significantly (P < 0.001) better with AMBER (3.2 +/- 0.6) than with the standard technique (1.9 +/- 0.6). The dorsal sinus showed alternatively a curved or pointed configuration.

Adult↗
PubMed2004

Evidence against the use of lumbar spine radiography for low back pain.

AIM: To review abnormalities reported on plain radiographic examination of the lumbar spine in patients referred with low back pain by general practitioners. Additionally, we evaluated and stratified the prevalence of these abnormalities by age. Finally, the diagnostic impact of lumbar spine radiography for the diagnosis of degenerative change, fracture, infection and possible tumour, was modelled. MATERIALS AND METHODS: A retrospective review of 2007 radiographic reports of patients referred with low back pain for lumbar spine radiography to a large radiology department was performed. The reports were classified into different diagnostic groups and subsequently stratified according to age. The potential diagnostic impact of lumbar spine radiography was modelled by using the prevalence of conditions studied as pre-test probabilities of disease. RESULTS: The prevalence of reported lumbar spine degeneration increased with age to 71% in patients aged 65-74 years. The overall prevalence of fracture, possible infection, possible tumour was low in our study population: 4, 0.8 and 0.7%, respectively. Fracture and possible infection showed no association with age. Possible tumour was only reported in patients older than 55 years of age. CONCLUSION: Although the prevalence of degenerative changes was high in older patients, the therapeutic consequences of diagnosing this abnormality are minor. The prevalence of possible serious conditions was very low in all age categories, which implies radiation exposure in many patients with no significant lesions.

Adolescent↗
PubMed2005

Validation of a decision instrument to limit pelvic radiography in blunt trauma.

We sought to validate a set of criteria that predict, with a high degree of sensitivity, which patients may safely forgo pelvic radiography in their initial trauma evaluation. This is a prospective observational study. Adult blunt trauma patients presenting from July 1, 2002 to June 30, 2003 who underwent pelvic radiography were eligible for the study. Physicians completed data sheets that outlined five criteria (altered level of consciousness, complaint of pelvic pain, pelvic tenderness on examination, distracting injury, clinical intoxication) before viewing pelvic radiographs. Final radiographic results were later added. Fractures were classified as clinically significant or insignificant based on the Tile classification. There were 973 patients enrolled in the study; 62 patients had pelvic fractures (prevalence 6.4%). The decision instrument predicted fracture in 60 patients, (sensitivity 96.8%, 95% CI 92.4-100%). Two fractures were clinically insignificant. If only clinically significant fractures were considered, the instrument had a sensitivity of 100%. The decision instrument predicted, with a high degree of sensitivity, those patients who could safely forgo pelvic radiography after blunt trauma. Approximately 44% of our patient population could have done without a pelvic X-ray, resulting in significant saving of health care dollars. These criteria need to be prospectively validated.

Cost-Benefit Analysis↗
PubMed2005

Traction radiography for the diagnosis of scapholunate ligament tears.

The diagnosis of scapholunate ligament injury by traction radiography was investigated within a consecutive study. The right wrists of 25 healthy volunteers and 22 wrists with arthroscopically proven complete scapholunate ligament tears were examined. Traction radiography was performed under fluoroscopy with a force of 5 kg applied to the thumb. In the normal wrists, this led to selective widening of the scapholunate joint space whereas the lunotriquetral distance remained unchanged. In 25 healthy right wrists, the median scapholunate distance measured 2.1 (range 1.3-2.6) mm on resting radiographs and 2.2 (range 1.7-3.5) mm on the stress radiographs. For the 22 wrists with complete scapholunate ligament tears, the median scapholunate distance was increased from 2.0 (range 1.0-3.0) mm to 3.8 (range 3.0-5.5) mm by traction (median difference of 1.8 (range 1.0-3.0) mm). In conclusion, a scapholunate distance of 3.0 mm or more in unloaded wrists or widening of the scapholunate interval by 1.0 mm or more under thumb traction should both be considered as pathological findings. We recommend traction radiography as a simple and valuable diagnostic procedure for suspected scapholunate ligament injury.

Adult↗
PubMed2006

Differences in trabecular structure between knees with and without osteoarthritis quantified by macro and standard radiography, respectively.

OBJECTIVE: To compare the sensitivity of standard and macro-radiography for quantifying cancellous bone differences between subjects with and without medial compartment knee osteoarthritis (OA). METHODS: Patients with medial compartment knee OA (n=24) and non-OA reference subjects (n=10) had a standard and a macro-radiograph (x4 magnification) of one knee. Fractal Signature Analysis (FSA), a computerised image analysis technique, measured differences in cancellous bone structure between OA and non-OA tibiae in all radiographs. RESULTS: Compared to non-OA, FSA of vertical trabeculae in macro-radiographs increased significantly (P<0.05) in the OA group at several trabecular widths (0.30-0.60mm, 0.7 mm, 0.98-1.14 mm) and in standard radiographs at a single trabecular width (0.48 mm). CONCLUSION: Compared to standard radiography, increased spatial resolution of macro-radiography allowed greater detection of trabecular bone differences between OA and non-OA knees. Nonetheless, difference was also detected in standard radiographs.

Adult↗
PubMed2006

Decreased in vitro interferon-gamma production in patients with cavitary tuberculosis on chest radiography.

Interferon (IFN)-gamma expression is altered in pulmonary lesions, such as cavities and granulomas. However, the exact association between patterns on chest radiography and IFN-gamma responses are unclear. The purpose of this study was to determine the IFN-gamma response in patients with tuberculosis and to correlate the pulmonary lesions with the IFN-gamma responses. We enrolled 78 patients with tuberculosis, as diagnosed with initial positive results for acid-fast bacilli in the sputum and final positive cultures for Mycobacterium tuberculosis. Cell cultures of stimulated peripheral blood mononuclear cells were performed. The supernatants were analyzed for the IFN-gamma response and the results statistically analyzed. The patients' chest radiographs were examined for fibronodules, masses, pleural effusion, cavities, and the severity of parenchymal involvement. IFN-gamma responses were lower in patients with cavities on chest radiography than in those without cavities (403.306+/-397.048 vs 698.154+/-593.436 pg/ml, P<0.05). IFN-gamma responses were also lower in patients with masses on chest radiography than in those without masses (186.345+/-200.724 vs 583.950+/-528.295 pg/ml, P<0.05). After regression analysis, the presence of a cavity was the only factor predictive of a decreased IFN-gamma response. We conclude that only chest radiographic pattern correlated with the IFN-gamma response was cavity formation. The administration of pharmacological IFN-gamma in tuberculosis patients with cavity may be considered.

Adult↗
PubMed2005

Condylar shape analysis using panoramic radiography units and conventional tomography.

OBJECTIVE: The objective of this study was to compare condyle shape between lateral temporomandibular joint (TMJ) images from axially corrected tomography and 3 panoramic radiography units with TMJ-specific programs. STUDY DESIGN: The TMJ from a single dry human skull was imaged with multidirectional tomography and the following 3 panoramic radiography units: Instrumentarium OP 100, Planmeca PM 2002 CC Proline, and Soredex Orthophos DS. A curve-fitting procedure (spline curves) was used to mathematically describe condyle outlines. One sample t tests were used to compare panoramic images against the tomograms (gold standard). RESULTS: A significant difference (P < .05) in condyle shape was found between TMJ tomography images and each of the 3 panoramic images. Images from the PM 2002 CC Proline demonstrated the smallest shape difference (13.4%), followed by the OP 100 (17.5%) and the Orthophos DS (24.8%). CONCLUSION: If panoramic radiography is to be used for the initial radiographic examination of the TMJ, practitioners should be aware of the potential for shape distortion of the condyle.

Analysis of Variance↗
PubMed1990

The application of clinical guidelines for skull radiography in the Accident and Emergency department: theory and practice.

Clinical guidelines for the selection of patients with head injuries for skull radiography, based on those formulated by the Royal College of Radiologists, were introduced into the Accident and Emergency department at the Manchester Royal Infirmary. Before the guidelines were implemented 94 skull X-rays were obtained per 1000 new casualty attenders. After implementation the rate of skull radiography initially fell by 40%, but thereafter slowly increased so that 12 months later it had returned to the pre-implementation level. During the first and second 6 months of the study reductions of 37% and 17%, respectively, were achieved. Although the overall annual reduction was only 27% an estimated saving of almost 10,000 pounds was made. Although clinical guidelines for skull radiography can reduce the number of skull radiographs without detriment to the care of the head-injured patient, their constant use is difficult to sustain. The application of clinical guidelines needs regular monitoring. Referring clinicians and radiologists need to be strongly motivated if such guidelines are to find a useful place in clinical management.

Adult↗
PubMed1994

Chest radiography guidelines for general practitioners: a practical approach.

An intensive programme of guideline development and dissemination is not always practical. We designed general practitioner guidelines for chest radiography and disseminated them to a group of 33 practices selected randomly from the practices that refer more than five patients for chest radiography annually. The subsequent 2500 requests were analysed and demographic data, the referring practice and the relevant history noted. We documented a reduction in the proportion of referrals that were contrary to the guidelines by 30.5% (from 8.2% to 5.7%, P = 0.016), a reduction in referral rate with an inadequate history by 29.7% (from 15.5% to 10.9%, P = 0.0008) and an increase in the frequency that a presumptive diagnosis was stated by 14.5% (from 42.9% to 49.1%, P = 0.0025). There was no overall reduction in referral rate in the study group and the reasons for this are discussed. We conclude that guidelines for chest radiography are effective in reducing inappropriate requests and can also improve the clinical information provided.

Adult↗
PubMed1980

Rationalising abdominal radiography in the accident and emergency department.

A retrospective analysis is presented of 100 consecutive patients attending an accident department and referred for abdominal radiography. In general the reasons for requesting supine films appeared sound. Five per cent of referrals were for haematemesis which is not a valid reason for plain radiography. An erect abdominal film as a routine request is indicated only in suspected intestinal obstruction (4% in this series), but 83% of patients were referred for both erect and supine films. If haematemesis were excluded as a reason for X-ray referral, and if erect films were limited to suspected intestinal obstruction, 95% of the patients would still have been referred for radiography, but almost half the abdominal films would not have been required. This would have reduced film wastage, workload and more important, gonadal irradiation.

Adolescent↗
PubMed1998

Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients.

BACKGROUND & AIMS: Guidelines on the type and frequency of follow-up of patients after curative surgery for colorectal cancer are unclear. The aim of this study was to determine the survival benefit of a planned follow-up program. METHODS: Three hundred twenty-five patients who underwent curative resection of colorectal cancer were prospectively randomized to either intensive or standard follow-up. After stratification according to Dukes' stage and site in the colon or rectum, patients were randomized to intensive follow-up of yearly colonoscopy, computerized tomography (CT) of the liver, and chest radiography and clinical review and simple screening vs. structured clinical review and simple screening tests only. RESULTS: On completion of 5-year follow-up, there was no significant difference in survival between the two groups. Yearly colonoscopy failed to detect any asymptomatic local recurrences. Only one asymptomatic curable metachronous colon tumor was detected. Liver CT resulted in earlier detection of hepatic metastases but did not increase the number of curative hepatectomies. Only 1 patient had an asymptomatic CT-detected liver metastasis, and another had an asymptomatic chest radiography-detected lung metastasis. Both had curative resections. CONCLUSIONS: Yearly colonoscopy, liver CT, and chest radiography will not improve survival from colorectal cancer when added to symptom and simple screening review.

Adult↗
PubMed1981

A comparison of ultrasonography and radiography in the localization of renal calculi: experimental and operative experience.

The capabilities of radiography (mammography film) and ultrasonography (7 MHz. probe) were investigated in cadaver kidneys. Stones of varying size and composition were studied. Clinically, 11 patients then were studied with intraoperative radiography and ultrasonography. Both techniques appeared to localize calculi more than 3 mm. with high consistency in cadaver kidneys and in patients. Real-time B scan ultrasonography is a rapid and accurate technique that has the ability to identify lucent calculi. When used in association with intraoperative radiography, intraoperative ultrasonography can be a great aid in the surgical removal of renal calculi.

Adult↗
PubMed1999

Alteration of computer dental radiography images.

This study was designed to determine if digital images stored on the hard drive of a Schick computer dental radiography system could be exported, altered, and then restored to the drive without any visible signs of alteration. Digital images were downloaded from the computer dental radiography system using an I-Omega Zip Drive, 100-MB capacity, and then opened in Corel Photo Paint where images were altered and manufacturer export symbols were edited. The resulting images were printed to a default printer (Fargo Foto Fun). The ease of manipulation of the exported digital images reflects the need for the manufacturer to implement safeguards so that the integrity of digital imaging cannot be compromised. Computer dental radiography has many advantages: conservation of time (instant radiographs), less radiation (50 to 60%), no chemical waste, and many viewing options. However, questions that might be raised regarding the ability of persons with minimal computer expertise, using a commercially available program to alter images should be addressed.

Computer Security↗
PubMed1976

Evaluation of radiography and isotopic scintigraphy for detecting skeletal metastases in breast cancer.

Experience with technetium-phosphate compounds for skeletal scintigraphy in patients with breast cancer was analysed. When tumours were 5 cm or less in diameter (T1-2N0-1M0) metastases were demonstrated by radiographs in 1-7% (2/114). However, when radiography did not demonstrate metastases, lesions were found by scintigraphy in 41-3% (19/46). When lesions demonstrated by scintigraphy at the same site as abnormalities regarded as "benign" by radiography were excluded, 23% (11/46) had scintigraphs strongly suggestive of metastases. It is proposed that routine radiographic skeletal survey for patients presenting with breast cancer be abandoned, and replaced by skeletal scintigraphy, chest radiography, and specific localised radiographs of lesions demonstrated by scintigraphy. It is suggested that with this policy the development of expertise in interpreting scintigraphs will be accelerated, the cost of pre-treatment assessment will be reduced, and clinical management rationalised.

Bone Neoplasms↗
PubMed2001

The role of postoperative chest radiography in pediatric tracheotomy.

A postoperative chest radiograph has traditionally been obtained after tracheotomies to evaluate for the presence of a pneumothorax and to assess tube position. Several recent studies in adults have questioned the usefulness of routine postoperative chest radiography in uncomplicated cases, but the role of post-operative chest radiography in pediatric patients has not been previously reviewed. We performed this study to examine the clinical utility of post-tracheotomy chest radiography in pediatric patients and determine if this routine practice impacts patient management enough to merit continued usage. A retrospective review was performed of 200 consecutive pediatric patients who underwent tracheotomies by the otolaryngology service in a tertiary care pediatric hospital from January 1994 to June 1999. All patients received postoperative chest radiographs. Five of 200 patients had a new postoperative radiographic finding, with three requiring interventions. Two patients required chest tube placement for pneumothorax, and one patient required tracheostomy tube change for repositioning. Fifty-one patients, including both pneumothoraces, exhibited clinical signs of pneumothorax (decreased breath sounds or oxygen saturation) in the immediate postoperative period. Chest X-ray ruled out a pneumothorax in the remaining 49 patients. The majority of these 51 patients were less than 2 years old (94%, P=0.002) or weighed less than 17 kg (89%, P=0.004). Postoperative chest X-rays yielded clinically relevant information in 168 patients that fell into one or more of four high risk categories: age less than 2, weight less than 17 kg, emergent procedures, or concomitant central line placement. Avoiding chest X-rays in the remaining 32 patients would have resulted in potential savings of $5000, which does not reflect the actuarial cost of a missed complication. Since the majority of our patients (84%) fell into a high-risk category, we feel it would be prudent to continue obtaining postoperative chest radiographs following all pediatric tracheotomies.

Chest Tubes↗
PubMed1990

Fracture of the carpal navicular--efficacy of clinical findings and improved diagnosis with six-view radiography.

A prospective study was conducted to determine the usefulness of clinical findings and 25-degree pronation and supination radiologic views to diagnose carpal navicular fractures. All patients presenting to the emergency department during a two-year period who fell on their outstretched hand and had pain and/or swelling in the anatomic snuffbox were evaluated initially and at two weeks. All patients received at least the standard four-view wrist radiography. If a fracture was not detected, two additional views were obtained. Ninety patients were enrolled; 54 fractures of the navicular were evident on initial four-view radiography. Thirty-six patients with a negative initial four-view radiograph had two additional views; 11 of the 36 were found to have a fracture. The other 25 patients failed to show fracture. In this series; no fractures were missed when six-view radiography was used. Anatomic snuffbox tenderness was 100% sensitive and 76% specific and had a 92% positive predictive value for carpal navicular fracture. We conclude that patients clinically suspected of carpal navicular fracture should undergo additional radiologic views if the standard four views of the wrist are negative.

Carpal Bones↗
PubMed1986

Chest radiography in the emergency department.

A review of the medical literature was carried out to determine guidelines for cost-effective and safe use of chest radiography in the emergency department. Screening radiographs are indicated in specific populations in the search for occult tuberculosis or carcinoma and in routine or preoperative cases. Radiography is clinically indicated in the asthmatic patient, the elderly patient, and the symptomatic patient, and its indications are modified by the patient's age and presenting signs and symptoms. Based on the information reviewed, rational guidelines for the use of chest radiography are presented.

Adult↗