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PubMed1990

The diagnostic value of subtraction radiography in the assessment of granular hydroxylapatite implants.

Although histologic analysis of osseous changes around hydroxylapatite (HA) implants can be highly accurate, it is of limited use in human beings. Digital subtraction radiography may provide a noninvasive alternative. Ten patients with bony lesions were operated on and nine of the iatrogenic defects were filled with granulated HA. In one patient, the defect was left unfilled for reference. Customized film holders provided standardized radiography. Follow-up images after 4 to 6 months were subtracted from immediately obtained postoperative images, and changes around the implants were noted. From ten pairs of radiographs, eight could be successfully subtracted, whereas two pairs required corrective image transformation before subtraction. Although no bone loss was observed in any of the patients, the implants did not appear to enhance physiologic bone regeneration either. Hence, subtraction radiography holds the potential of clinical utility for the follow-up of HA implants. However, technical improvements are necessary to yield quantitative data.

Adult↗
PubMedDate not supplied

Occult ankle fracture detected by an ankle effusion on plain radiography: a case report.

Subtle ankle fractures may escape detection on plain radiography. These occult fractures can cause prolonged disability and pain. We present a case of blunt ankle trauma where plain radiography failed to reveal any bony abnormalities. The recognition of an ankle effusion on plain radiographs prompted us to perform a computed tomography (CT) scan of the ankle. The CT scan demonstrated an anterior plafond fracture of the distal tibia, which required surgical fixation. Had the fracture not been identified, our patient would have been treated inappropriately for a ligament sprain. An occult fracture should be suspected if an ankle is grossly swollen after blunt trauma, and plain radiography demonstrates an effusion. In this circumstance, performance of further imaging studies, such as conventional or CT, are advised to rule out an occult ankle fracture.

Adult↗
PubMed2004

Neutron radiography and other NDE tests of main rotor helicopter blades.

A few nondestructive examination (NDE) techniques are extensively being used worldwide to investigate aircraft structures for all types of defects. The detection of corrosion and delaminations, which are believed to be the major initiators of defects leading to aircraft structural failures, are addressed by various NDE techniques. In a combined investigation by means of visual inspection, X-ray radiography and shearography on helicopter main rotor blades, neutron radiography (NRad) at SAFARI-1 research reactor operated by Necsa, was performed to introduce this form of NDE testing to the South African aviation industry to be evaluated for applicability. The results of the shearography, visual inspection and NRad techniques are compared in this paper. The main features and advantages of neutron radiography, within the framework of these investigations, will be highlighted.

Journal Article↗
PubMed2005

A new plain radiography method using the optimal angle of knee flexion for assessing early degeneration of the knee joint.

During total knee arthroplasty for primary osteoarthritis, we measured the area of worn cartilage on the medial femoral condyle in 44 knees. By reference to a lateral femoral radiograph of each knee, the optimal knee flexion angle-reflecting the worn area of the femoral condyle-was determined and found to be 19.8 degrees +/- 7.6 degrees. Using this result, a new method for posteroanterior radiography of the weight-bearing knee (20/10 radiography) was devised. We compared the use of our method with Rosenberg's method in 56 varus knees and found that the width of the cartilage space determined by our method was narrower than that determined by Rosenberg's method (t test, <0.001). These results confirmed that 20/10 radiography well reflects the region of worn cartilage in knees with early-stage primary osteoarthritis.

Adult↗
PubMed2004

Differential diagnosis of rheumatic diseases using conventional radiography.

The approach to the differential diagnosis of rheumatic diseases using conventional radiography is systematic and module-oriented, which, with respect to future developments, forms the basis for computer-assisted diagnosis (CAD). The indications follow consensus-based referral criteria and attempts should be made to raise the evidence level of the recommendations. Investigation techniques have been improved in the last few years with the use of digital radiography. New imaging technologies may be available in the future that will achieve at least the same quality of images, while exposing patients to a significantly lower radiation dose. The interpretation of radiographical signs could be enhanced through a correlation with other imaging modalities. Computer-assisted techniques with image processing tools for automated measurements, lesion detection and in the form of expert systems are under development. With conventional radiography embedded in CAD systems, promising options will be available to enhance the differential diagnosis of rheumatic diseases.

Arthrography↗
PubMed2003

Radiography-based treatment planning compared with computed tomography (CT)-based treatment planning for intracavitary brachytherapy in cancer of the cervix: analysis of dose-volume histograms.

PURPOSE: To analyze the dose-volume histograms (DVHs) of the tumor volume and organs at risk by CT-based treatment planning compared with conventional radiography-based treatment planning for intracavitary brachytherapy in cancer of the cervix. METHODS AND MATERIALS: Fifteen consecutive patients with cancer of the cervix (1 IB1, 3 IB2, 7 IIB, 4 IIIB) were treated with plastic CT-compatible HDR intracavitary applicators and underwent postimplant pelvic CT scans with applicators in place. CT-images were transferred to the PLATO treatment planning system. The gross tumor volume (GTV) and organs at risk were digitized. Dwell positions in the uterine tandem and colpostats were identified and registered for each patient. All patients were treated with 6 Gy per fraction to Point A using radiography-based planning. For the CT-based planning, DVHs were performed for the GTV, bladder, rectum, sigmoid colon, and small bowel in the pelvis. The dose delivered to 3% volume of the organs at risk (D3%) was compared with the respective ICRU reference doses. RESULTS: For stage IB(I), IB2, IIB, and IIIB disease the mean GTV was 20.5 cc, 56.6 cc (54.2-57.2), 63.7 cc (55.4-118.9), and 77.6 cc (49.4-102.9), respectively. The 6 Gy pear-shaped volume (PSV) encompassed an average GTV of 98.5%, 89.5%, 79.5%, and 59.5% for stages IBI, IB2, IIB, and IIIB, respectively. The mean dose for the ICRU bladder point and D3% was 3.72 Gy (1.51-5.53) and 4.74 Gy (1.70-10.10), respectively. The mean dose for the ICRU rectal point and D3% was 3.97 Gy (2.09-5.37) and 3.52 Gy (2.05-4.08), respectively. The D3% for the sigmoid colon was highest (3.88 Gy), followed by the rectum (3.52 Gy), and the small bowel (3.36 Gy). CONCLUSION: Radiography-based conventional treatment planning overestimates tumor dose, especially those with more advanced tumors. To correlate DVHs for tumor control, improved tumor imaging is necessary.

Brachytherapy↗
PubMedDate not supplied

Acromioclavicular joint osteoarthritis: comparison of findings derived from MR imaging and conventional radiography.

The purpose of this study was to determine the correlation between routine radiography and magnetic resonance (MR) imaging in the analysis of the acromioclavicular (AC) joint osteoarthritis (OA). MR imaging studies of the shoulder in 50 patients performed over a 1-year period at a single institution with corresponding conventional radiographic examinations performed within 1 month of the MR imaging study were restrospectively evaluated by the consensus of two musculoskeletal radiologists with special attention to the AC joint. As conclusion, information provided by conventional radiography in the analysis of AC joint OA does not correlate with that provided by MR imaging. AC joint OA is more frequently detected with MR imaging than with radiography. MR imaging provides better assessment of the full extent of AC joint OA and its effect on the underlying RC.

Acromioclavicular Joint↗
PubMed1993

Acute pulmonary complications in immunocompromised non-AIDS patients: comparison of diagnostic accuracy of CT and chest radiography.

To compare the abilities of computed tomography (CT) and radiography in detection and diagnosis of acute pulmonary complications in immunocompromised non-AIDS patients, the CT scans and radiographs of 45 immunocompromised non-AIDS patients with proven pulmonary disease and 20 normal controls were independently assessed by two observers, without knowledge of clinical or pathologic data. The observers listed the three most likely diagnoses and their degree of confidence in the first-choice diagnosis on a three-point scale. The sensitivity and specificity in detecting pulmonary complications was 100% and 98% for CT, compared to 98% and 93%, respectively, for chest radiography. In the immunocompromised patients, the first-choice diagnosis was correct in 44% of CT and 30% of radiograph readings (P < 0.01). The correct diagnosis was among the top three diagnoses in 70% of CT scans and 53% of radiograph readings (P < 0.01). Confidence level one (definite) was reached in 33% of CT scans and 10% of chest radiographs (P < 0.001). Diseases with a dominant nodular pattern had a higher occurrence of correct first-choice diagnosis (62% vs 34%, P < 0.02) and level one confidence ratings (53% vs 13%, P < 0.001) than diseases with ground-glass opacity, consolidation or irregular linear opacities. We conclude that chest radiographs and CT scans have comparable sensitivity in detecting acute pulmonary complications in immunocompromised non-AIDS patients. CT is superior to chest radiography in the differential diagnosis of acute pulmonary complications in these patients.

Acute Disease↗
PubMed1993

Phosphor plate computed radiography: response to variation in mAs at fixed kVp in an animal model. Potential role in neonatal imaging.

Computed digital radiography offers a number of potential advantages over conventional film-screen imaging. To determine the applicability of these to portable neonatal examinations we performed a controlled prospective study comparing conventional 200 speed film-screen with a computed radiography unit in an animal model. Images acceptable for diagnostic purposes were obtained on the digital system over an exposure range many orders of magnitude greater than was possible on the film-screen system. Digital imaging offers potential for elimination of repeat examinations due to suboptimal exposure factors, and for reduction in radiation dose to the patient. We believe that computed digital radiography should be particularly suited to portable neonatal imaging.

Animals↗
PubMed1988

Digital radiography in an intensive care unit.

Mobile chest radiographs obtained in the intensive care unit with a computed radiography system (one of the digital radiography systems) and a conventional screen-film technique were initially compared in 54 pairs. Features such as the air spaces and interstitium of the lungs, the mediastinum, pulmonary vessels, the tracheobronchial tree, and catheters and other devices were compared in both methods. The computed radiography system demonstrated good visualisation of the mediastinum, pulmonary vessels, the tracheobronchial tree, catheters and other devices. Automatic adjustment of the sensitivity and the wide dynamic range of this system were thought to be responsible for the decrease in the number of retakes even in patients with massive fluid collections. The few artefacts created by digital processing were mostly overcome by a routine use of simultaneous display of two different types of image processing.

Aged↗
PubMed1990

Prospective comparison of plain abdominal radiography with conventional and digital renal tomography in assessing renal extracorporeal shock wave lithotripsy patients.

Most publications citing the effectiveness of renal extracorporeal shock wave lithotripsy have used plain abdominal radiography to assess residual calculi after treatment. We compared radiologist sensitivity and specificity in the detection of calculi on plain abdominal radiographs versus conventional film-screen and digital renal tomograms in extracorporeal shock wave lithotripsy patients. Of the patients 50 were imaged before and within 24 hours after lithotripsy. Six radiologists evaluated the resultant 300 studies for the presence and location of calculi. The mean sensitivity for digital tomograms was 83% for pre-lithotripsy and post-lithotripsy studies, which was significantly higher than for plain abdominal radiography and conventional tomography after lithotripsy. However, there were significantly more false positive stone diagnoses associated with digital tomogram interpretation. Signal detection analysis verified the over-all superiority of digital tomography for post-extracorporeal shock wave lithotripsy imaging. Calculus detection by conventional and digital tomography is superior to detection by plain abdominal radiography. However, because we did not perform delayed imaging, it is not possible to say what impact digital tomography might have on the management of extracorporeal shock wave lithotripsy patients.

Humans↗
PubMed1997

Computed radiography in musculoskeletal imaging.

In conclusion, CR offers many advantages in comparison with conventional radiography. Musculoskeletal radiology particularly benefits from the wide dynamic range and image-processing capabilities of CR. Most studies have not shown a statistically significant difference in observer performance (diagnostic accuracy) of CR in comparison with conventional radiography in musculoskeletal applications. In addition, dose reduction in the range of 25% to 50% is possible with many musculoskeletal images. However, disadvantages are also apparent and include reduced spatial resolution, increased noise, and change in image size and format. Overall, the advantages of CR and digital technology outweigh its limitations and for these reasons continue to promote the conversion from conventional radiography.

Adult↗
PubMed2002

Prospective study on ultrasonography plus plain radiography in predicting residual obstruction after extracorporeal shock wave lithotripsy for ureteral stones.

OBJECTIVES: To compare ultrasonography (US) and plain radiography with intravenous urography (IVU) in predicting ureteral obstruction after in situ extracorporeal shock wave lithotripsy (ESWL) for ureteral stones. METHODS: From April 1998 to September 2000, 100 consecutive patients with solitary ureteral stones were treated by primary in situ ESWL. ESWL failures were salvaged by ureteroscopic lithotripsy. Ninety-three patients completed the follow-up assessment. US and IVU were performed when plain radiography showed no residual stone. The occurrence of hydronephrosis on US was compared with IVU, the reference standard for ureteral obstruction. RESULTS: Of the 93 patients, 72 were men and 21 women (mean age 52 years; mean stone size 11.2 mm). ESWL successfully treated 70 ureteral stones (75%), and the 23 failures were treated by ureteroscopic lithotripsy. Sixty-nine patients without hydronephrosis on US had no ureteral obstruction on IVU. Of the 24 patients who had hydronephrosis on US, 8 had ureteral obstruction on IVU. Of the 85 patients who had no ureteral obstruction on IVU, 69 patients showed no evidence of hydronephrosis on US. However, all patients with ureteral obstruction on IVU demonstrated hydronephrosis on US. The sensitivity, specificity, and positive and negative predictive value concerning sonographic hydronephrosis in the prediction of ureteral obstruction was 100%, 81%, 33%, and 100%, respectively. US alone could not define the cause of ureteral obstruction. CONCLUSIONS: Plain abdominal radiography plus US is highly sensitive for screening ureteral obstruction after primary in situ ESWL for ureteral calculi. It can save up to 74% of patients from the potential risk of IVU. The detection of the cause of obstruction by IVU is only necessary when sonographic evidence of hydronephrosis is present.

Adult↗
PubMed1996

Physical and clinical evaluation of a 2,048 x 2,048-matrix image intensifier TV digital imaging system in bone radiography.

RATIONALE AND OBJECTIVES: To evaluate the potential utility of a 2,048 x 2,048-matrix image intensifier television digital radiography (DR) system versus a conventional screen-film (S-F) system for bone radiography. METHODS: Basic imaging properties were evaluated including resolution properties, Wiener spectra, and detectabilities of low-contrast signals. DR images were obtained with the same exposure (iso-dose) or one-third the exposure (low-dose) used with the S-F system. The visibility of pathologic details of metastatic disease on bone radiographs of 27 patients was evaluated subjectively by six radiologists. RESULTS: Resolution properties of the DR system were slightly superior to those of the S-F system at low-frequency range, but the S-F system showed considerably higher resolution properties at the high-frequency range. The noise levels for iso-dose DR were slightly greater than those for S-F imaging at low spatial frequency; however, low-dose digital radiographs showed higher noise levels. Visibility of details of diagnostic features on bone radiographs was similar with both systems, but the low-dose digital radiographs were slightly inferior. CONCLUSION: High-resolution image intensifier television DR systems may be clinically useful for bone radiography.

Bone Neoplasms↗
PubMed1999

Evaluation of robot-based registration for subtraction radiography.

Digital subtraction of (plane film) radiographs of an area of interest taken over time is a powerful diagnostic tool. In dentistry for example, this is used to detect and treat periodontal disease (i.e. the sequence of diseases that leads to the loss of bone supporting the teeth). A precondition of subtraction radiography is correct three-dimensional registration of the film and X-ray source, without which the subtraction images are meaningless. A small misalignment can be compensated for by post-processing of the digitized films (by correspondence and rectification) to remove artifacts due to positioning errors. This paper presents a novel approach to subtraction radiography which replaces customary mechanical alignment methods (such as a stent or cephalostat) with a robot. A mechanical stent is a short rod attached at one end to the X-ray source and at the other to a mechanical appliance protruding from the patient's mouth. An experimental system was constructed which creates a 'sensorized stent' by integrating a plastic mouth appliance (with the impression of the patient's teeth), a robot carrying an X-ray source and a host computer. Results showed that the robotic system was superior to the mechanical alignment approach, due to its excellent accuracy and repeatability. This resulted in much less variation in the non-registered X-ray images, and in a smaller standard deviation in the intensities of subtracted images overall. The results suggest that in the future, diagnostic studies including subtraction radiography will not need either mechanical alignment (which is imprecise) or post-processing registration (which is time consuming).

Cadaver↗
PubMed1999

[The reduction of the radiation dosage by means of storage phosphor-film radiography compared to a conventional film-screen system with a grid cassette on a skull phantom].

PURPOSE: How much can the radiation dose be reduced for skull radiography by using digital luminescence radiography (DLR) compared to a conventional screen film system with a grid cassette? METHODS AND MATERIALS: A skull phantom (3M) was x-rayed in anterior-posterior orientation using both a conventional screen film system with grid cassette and DLR (ADC-70, Agfa). The tube current time product (mAs) was diminished gradually while keeping the voltage constant. The surface entrance dose was measured by a sensor of Dosimax (Wellhöfer). Five investigators evaluated the images by characteristic and critical features, spatial resolution and contrast. RESULTS: The surface entrance dose at 73 kV/22 mAs was 0.432 mGy in conventional screen film system and 0.435 mGy in DLR. The images could be evaluated very well down to an average dose of 71% (0.308 mGy; SD 0.050); sufficient images were obtained down to an average dose of 31% (0.136 mGy; SD 0.065). The resolution of the line pairs were reduced down to 2 levels depending on the investigator. Contrast was assessed as being very good to sufficient. The acceptance of the postprocessed images (MUSICA-software) was individually different and resulted in an improvement of the assessment of bone structures and contrast in higher dose ranges only. CONCLUSION: For the sufficient assessment of a possible fracture/of paranasal sinuses/of measurement of the skull the dose can be reduced to at least 56% (phi 31%; SD 14.9%)/40% (phi 27%; SD 9.3%)/18% (phi 14%; SD 4.4%). Digital radiography allows question-referred exposure parameters with clearly reduced dose, so e.g. for fracture exclusion 73 kV/12.5 mAs and to skull measurement 73 kV/4 mAs.

Evaluation Studies as Topic↗
PubMed1998

[A new specimen radiography device with a maximum 20-fold magnification for breast diagnosis].

PURPOSE: A radiography system specially developed for specimen radiography and allowing maximal 20-fold magnification is presented. The efficiency of the system was tested and compared with that of conventional magnification mammography systems. METHODS: 23 surgical and 90 core biopsies of the breast were examined for detection of microcalcifications. As criteria the number of identifiable calcifications, their shape and configuration as well as tissue contrast were chosen. RESULTS: The new technique detected about 400% more microcalcifications, 200% more core and 50% more surgical biopsies containing calcifications. Thus, in a few cases, additional core biopsies were unnecessary. Moreover, this new system yielded additional information for the pathologist and surgeon concerning the exact localisation of suspicious lesions that facilitated working up specimens, or indicated additional surgical removal in special cases. CONCLUSIONS: By identification of malignant lesions not detectable with conventional magnification radiography systems, as well as a more exact localisation of suspicious lesions, false negative results may be reduced.

Biopsy↗
PubMed1993

[X-ray studies of the peripheral joints: a comparison of digital luminescence radiography (DLR) and film-screen systems].

175 matched skeletal x-ray examinations were carried out by digital luminescent radiography (DLR) and conventional screen-film system combinations. In digital luminescent radiography (DLR) two differently postprocessed images were obtained from one x-ray exposure: A display with low spatial frequency enhancement was opposed to a second display with high edge enhancement. Conventional and digital images were evaluated randomly and separately by four radiologists using a questionnaire. DLR proved to be diagnostically equivalent to the conventional technique except for a diminished visibility of subtle erosions and fissures. As major advantages of DLR maybe pointed out that faulty exposures were avoided by the automatic adjustment of image brightness and that the soft tissue margins could be more easily delineated in displays with high edge enhancement than in conventional radiography. However, digital displays with high edge enhancement did not provide additional diagnostic information and led to artifacts at the edges of metal prostheses.

Adult↗