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PubMed1987

Metastatic calcification of the heart and lungs in end-stage renal disease: detection and quantification by dual-energy digital chest radiography.

Metastatic calcification of the lung and heart can cause severe cardiopulmonary compromise and death. Although it is found in most end-stage renal disease patients at autopsy, it is only rarely detected during life. Using a prototype dual-energy digital chest radiographic unit, we measured calcium content (mg/cm2) over the lung and heart in 32 hemodialysis patients. Pulmonary calcium content was significantly greater in these patients than in sex-matched control subjects (men, 230 +/- 43 [mean +/- standard error] vs 166 +/- 7, p less than .05; women, 168 +/- 19 vs 110 +/- 7.5, p less than .001). Abnormal values were detected by dual-energy radiography in 44% of patients (vs 9% of patients studied by conventional radiography). Cardiac calcium content was also significantly greater in the hemodialysis patients than in the control subjects (259 +/- 14 vs 184 +/- 8, p less than .05). Metastatic calcification was significantly correlated with elevated phosphate and calcium-phosphate product levels. Patients with significantly elevated pulmonary calcium content had evidence of restrictive lung disease by functional testing. There was an inverse correlation between elevated cardiac calcium content and ejection fraction. We conclude that dual-energy digital radiography allows premortem diagnosis of metastatic visceral calcification and is more sensitive than current techniques.

Adult↗
PubMed1988

Efficacy of specimen radiography of clinically occult noncalcified breast lesions.

Breast biopsy specimen radiography is required to ensure the accurate removal of clinically occult lesions discovered by mammography. Although used routinely for calcified lesions, it has not been widely accepted for those abnormalities that do not contain calcium. To determine the efficacy of film-screen specimen radiography for confirming the presence of clinically occult, noncalcified lesions, we undertook a prospective study of 104 specimen radiographs obtained after mammographically guided hookwire localization and planned excision of these lesions. Ninety-seven (93%) of the excised abnormalities were visualized on specimen mammograms. Malignancy was found in 22 (21%) of them. Thirty-five percent of the specimen radiographs showed better anatomic detail of the lesion, 48% showed the same detail, and 16% showed less detail than the original mammograms. Specimen radiographs failed to show the lesion in only seven cases. Five of the seven were true-negative specimen radiographs, making the efficacy rate 98%. Film-screen specimen radiography of clinically occult, noncalcified lesions is a highly effective procedure for correctly identifying the presence of a mammographic abnormality.

Breast Diseases↗
PubMed1993

Prevalence and duration of postoperative pneumoperitoneum: sensitivity of CT vs left lateral decubitus radiography.

OBJECTIVE: The purpose of this study was to evaluate the prevalence, location, and duration of pneumoperitoneum in postoperative patients and to compare the sensitivities of CT and left lateral decubitus radiography in the detection of postoperative pneumoperitoneum. SUBJECTS AND METHODS: Twenty-seven CT scans and 27 abdominal radiographs with the patient in the left lateral decubitus position were obtained prospectively in 17 patients after uncomplicated abdominal surgery. Fifteen patients were examined 3 days after surgery and 12 were examined 6 days after surgery. The studies were evaluated in a blinded fashion for the presence, location, and volume of free air. The presence of air on the radiographs and the presence and quantity of air on the CT scans were correlated with each subject's surgical procedure, age, sex, and body habitus. RESULTS: Pneumoperitoneum was seen on 13 (87%) of 15 CT scans and eight (53%) of 15 radiographs obtained 3 days after surgery and on six (50%) of 12 CT scans and one (8%) of 12 radiographs obtained 6 days after surgery. The calculated volume of free air seen on the CT scans ranged from 0.3 to 5.8 ml. Sixty-two percent of collections by volume were located in the midline/parahepatic space, 22% in the pelvis, and 16% in the mesentery. Radiographs showed pneumoperitoneum in only nine (47%) of 19 examinations in which the corresponding CT scans showed free air. Findings on radiographs were false-negative in seven (87%) of eight obese patients in whom pneumoperitoneum was detected on CT scans. CONCLUSION: The prevalence of pneumoperitoneum in the postoperative period based on CT findings is greater than that previously reported. Small amounts of pneumoperitoneum frequently collect along the anterior abdominal wall in two preferential spaces, the pararectus and midrectus recesses. The results of this study show that CT is significantly more sensitive than plain radiography for detecting small amounts of free intraperitoneal air in postoperative patients. Radiography is particularly insensitive for imaging obese and heavy patients.

Adult↗
PubMed1997

Screen-film versus computed radiography imaging of the hand: a direct comparison.

OBJECTIVE: Computed radiography of the musculoskeletal system has the potential to become a powerful tool in the practice of diagnostic radiology. It addresses many of the geographic and film-distribution concerns facing diagnostic imaging. We undertook this study to compare and document the quality of computed radiographs and conventional screen-film images before widespread implementation. MATERIALS AND METHODS: We evaluated clinical images using direct comparison. Bilateral hand images from 50 patients were scored independently by six musculoskeletal radiologists. In each case one hand was imaged with a conventional screen-film technique and the other with computed radiography. Images were masked to eliminate as much bias as possible. The numeric scores assigned to the images by the observers were analyzed using Student's t test. RESULTS: Computed radiographs were judged with statistical significance to be better than conventional screen-film images in all features judged by the observers, including bone cortex, bone trabeculae, corticomedullary junction, distal phalangeal tuft, soft tissues, fat planes, bone-soft-tissue interface, and overall contrast and density. CONCLUSION: The statistically significant determination that the image quality of computed radiographs is at least as good as screen-film images allows confident use of computed radiography and enables radiologists to take advantage of its many other practical capabilities related to image distribution, storage, cost, and geographic coverage without sacrificing image quality.

Adult↗
PubMed1999

Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes.

OBJECTIVE: The goal of this study was to compare the capabilities of conventional radiography, CT, and MR imaging in revealing ligamentous and bony changes in patients after hyperflexion injuries. SUBJECTS AND METHODS: Forty-nine patients with hyperflexion injuries of the foot were included in our study. Conventional radiography, weight-bearing radiography, CT, and MR imaging were performed. All images were reviewed with respect to ligamentous and bony abnormalities and alignment alterations. Eleven patients with joint malalignment underwent surgery, which is considered the gold standard in these patients. Five patients with joint malalignment refused surgery. RESULTS: For all 49 patients, conventional radiographs revealed 33 metatarsal and 20 tarsal fractures. Eight patients presented with tarsometatarsal joint (Lisfranc's joint) malalignment. Weight-bearing radiographs showed joint malalignment in the same eight patients only. CT showed 41 tarsal fractures and 53 metatarsal fractures. Joint malalignment was evident in 16 patients. MR imaging revealed 41 metatarsal fractures and 18 metatarsal bone bruises. Tarsal bones were fractured at 39 sites and there were nine tarsal bone bruises. Metatarsal fractures were mostly localized in the second metatarsal bone; tarsal fractures, in the cuboid. Joint malalignment was evident in 16 patients; in 11 of these 16 patients, Lisfranc's ligament was disrupted. Surgery confirmed bony and ligamentous changes and joint malalignment in 11 patients. CONCLUSION: Conventional radiographs including weight-bearing images are not sufficient for routine diagnostic workup of patients with acute hyperflexion injuries of the foot. CT should serve as the primary imaging technique for such patients.

Adolescent↗
PubMed1992

Subtraction radiography of interradicular bone lesions.

Subtraction and conventional radiography were evaluated for their diagnostic potential to assess interradicular bone lesions in the mandibular premolar region. Both conventional radiographs and subtraction images were interpreted by 10 observers. The receiver-operating characteristic (ROC) technique was used to compare the two techniques. The diagnostic validity was higher for the subtraction technique, both for lesions confined to cancellous bone and for lesions including the cortical bone, than for the conventional technique. For bone defects confined to cancellous bone the diagnostic accuracy was lower than those reported from periapical bone lesions irrespective of whether subtraction or conventional radiography was used. We conclude that subtraction radiography improves the detectability of bone lesions, shallow ones in particular. Lesions in the interradicular bone are more difficult to detect than those in the periapical bone.

Alveolar Process↗
PubMed2005

[Clinical efficacy of image processing of grid detection and suppression (GDS) in computed radiography].

In projection radiography, stationary grids are indispensable accessories to the improvement of diagnostic imaging. On the other hand, they are becoming one of the issues facing digital image processing. The lead foil that composes the grid can produce moiré on printed films and monitors according to the sampling interval at which the image is read by computed radiography (CR), creating a major obstacle to diagnosing images. The subject of this study on Grid Detection and Suppression (GDS) was the development of comprehensive image-processing software to detect and suppress grid lines automatically. Our results showed that applying GDS parameters 3 approximately 5 could provide a sufficient effect on suppression with little impact on images through the use of a multi-purpose grid (grid ratio 8:1, density 34 lp/cm) for general purposes. In projection radiography, it is expected that soft copy diagnosis will increase because the digital transition is proceeding, and the establishment of high-speed networks is becoming easier. Therefore, the digital environment is expected to improve and the choice of grids and monitors to expand, by using software such as GDS that does not require special skills.

Data Display↗
PubMed1989

A financial analysis of digital image acquisition for portable and table-top radiography.

The use of photostimulable phosphors as a method for obtaining digital radiographic images during traditional portable and table-top radiography has become a subject of increased interest and controversy in recent years. Proponents of this technology argue that a Picture Archival and Communications System--or PACS--is now within the grasp of most medical communities. However, there still exists concerns relating to the financial and economic effectiveness of this technological development. Does direct digital image acquisition during portable and table-top radiography present a financial benefit to the average health care facility? An in-depth financial analysis of the costs incurred by computed radiographic imaging provides sufficient information to state that financial benefits are a function of exposure-related repeat procedure volumes which can be reduced or eliminated through the use of this new technology. Repeat procedure volumes must be reduced by at least 6,000 procedures if the health care facility intends to avoid a financial loss from the use of photostimulable phosphor technology during portable and table-top radiography.

Capital Expenditures↗
PubMed2002

Radiation dose and image quality in diagnostic radiology. Optimization of the dose-image quality relationship with clinical experience from scoliosis radiography, coronary intervention and a flat-panel digital detector.

UNLABELLED: X-rays are known to cause malignancies, skin damage and other side effects and they are thus potentially dangerous. Therefore, it is essential and in fact mandatory to reduce the radiation dose in diagnostic radiology as far as possible. This is also known as the ALARA (as low as reasonably achievable) principle. However, the dose is linked to image quality and the image quality may not be lowered so far that it jeopardizes the diagnostic outcome of a radiographic procedure. The process of reaching this balance between dose and image quality is called optimization. The aim of this thesis was to propose and evaluate methods for optimizing the radiation dose-image quality relationship in diagnostic radiography with a focus on clinical usefulness. The work was performed in three main parts. OPTIMIZATION OF SCOLIOSIS RADIOGRAPHY: In the first part, two recently developed methods for digital scoliosis radiography (digital exposure and pulse fluoroscopy) were evaluated and compared to the standard screen-film method. Radiation dose was measured as kerma area-product (KAP), entrance surface dose (ESD) and effective dose; image quality was assessed with a contrast-detail phantom and through visual grading analysis. Accuracy in angle measurements was also evaluated. The radiation dose for digital exposure was nearly twice as high as the screen-film method at a comparable image quality while the dose for pulsed fluoroscopy was very low but with a considerably lower image quality. The variability in angle measurements was sufficiently low for all methods. Then, the digital exposure protocol was optimized to a considerably lower dose with a slightly lower image quality compared to the baseline. FLAT-PANEL DETECTOR: In the second part, an amorphous-silicon direct digital flat-panel detector was evaluated using a contrast-detail phantom, measuring dose as entrance dose. The flat-panel detector yielded a superior image quality at a lower dose than both storage phosphor plates and screen-film. Equivalent image quality compared to storage phosphor plates was reached at about one-third of the dose. OPTIMIZATION OF PERCUTANEOUS CORONARY INTERVENTION (PCI): In the third part, influence of various settings on radiation dose and image quality in coronary catheterisation and PCI was investigated. Based on these findings, the dose rate for fluoroscopy was reduced to one-third. The dose reduction was evaluated in a clinical series of 154 PCI procedures before and 138 after the optimization. Through this optimization, the total KAP was significantly reduced to two-thirds of the original value. IN SUMMARY: This thesis indicates the possibility of dose reduction in diagnostic radiology through optimization of the radiographic process.

Coronary Angiography↗
PubMed1992

Comparison of computed tomography and radiography for detecting changes induced by malignant nasal neoplasia in dogs.

The ability of computed tomography and radiography to detect changes associated with nasal neoplasia was compared in dogs. Eighteen areas or anatomic structures were evaluated in 21 dogs for changes indicative of neoplasia. Computed tomography was superior (P < or = 0.05) to radiography for detecting changes in 14 of 18 areas. Radiography was not superior for detecting changes in any structure or area. Computed tomography reveals vital information not always detected radiographically to assist in providing a prognosis and in planning treatment for nasal neoplasms in dogs.

Adenocarcinoma↗
PubMed2005

New polymer materials in total hip arthroplasty. Evaluation with radiostereometry, bone densitometry, radiography and clinical parameters.

AIMS: To evaluate the outcome of different types of polyethylene, bone cements and one design of uncemented fixation with porous and ceramic coating using radiostereometry, bone densitometry, conventional radiography and clinical parameters. MATERIALS AND METHODS: Study I: 201 patients were extracted from 5 prospective randomised studies to evaluate femoral head penetration at two years with radiostereometry in four basic designs, cemented Lubinus and Reflection cups, uncemented Trilogy and Reflection cups. Studies II and III: 60 patients (61 hips) were randomised to receive either highly cross-linked or conventional all PE cups. 32 patients with bilateral arthrosis received hybrid THA with highly cross-linked PE on one side and conventional on the contra lateral side. Femoral head penetration and the migration of the cups were evaluated with radiostereometry in the supine and standing positions. DEXA and conventional radiography were used to evaluate the bone mineral density and radiolucencies around the cemented acetabular component. Studies IV and V: 90 patients (97 and 96 hips respectively) were stratified depended on age, gender, diagnosis and preoperative BMD to create 3 main groups of socket fixation. In the first group fluoride containing cement was used, in the second group Palacos cum Gentamicin and in the third hybrid THA with porous coated HA/TCP cup. In the hybrid group the fixation of the femoral component was again randomised to either of the two cements. The results on femoral and acetabular sides are presented separately in studies IV and V, respectively. RESULTS: Study I: Cups with polyethylene sterilized in EtO had almost twice the proximal and 3D penetration rates compared with gamma-sterilized polyethylene. Regression analysis showed that the type of sterilization, age and weight was the most important factors affecting the penetration rate. Studies II and III: In the cemented study the proximal penetration was lower in the study group independent of position at 3 years, while in the hybrid study the penetration was lower in the study group only in the supine position at 2 years. The migration of the cup did not differ between the plastics in both studies. At 2 years the periprosthetic radiolucency and BMD did not differ significantly between the 2 types of PE used in the cemented study. Study IV: The subsidence of the stem did not differ between the groups, but the periprosthetic BMD decreased more in fluoride cement group at 2 years. Conventional radiography revealed higher progression of radiolucent lines in the Palacos group, but only in one region. Study V: The proximal migration of the cup was almost similar in all three groups. The three dimensional migration was increased in patients with osteoporosis. Postoperative radiolucent lines tended to disappear with use of porous coating covered with HA/TCP. CONCLUSIONS: Study I: EtO sterilized polyethylene increased the femoral head penetration. Age and weight were also important predictors of the penetration rate. Studies II and III: The highly cross-linked polyethylene decreased the penetration rate mainly after one year probably reflecting less wear. The different mechanical properties of the two types of PE studied did not affect the early fixation of the cemented cup. Study IV: There were no obvious advantage of addition of fluoride to acrylic bone cement when used to fixate the femoral component. Study V: Use of fluoride containing cement or uncemented fixation did not improve the early stability of the socket compared to Palacos with Gentamicin.

Absorptiometry, Photon↗
PubMed1992

Pelvic lymph node metastases in cervical cancer: comparison of lymphography, inspection, radiography, and histologic examination of lymph nodes.

Lymphangiography is commonly performed in the pretreatment evaluation of patients with cervical carcinoma, but its value is controversial. The purpose of this report is to determine the reliability of lymphography in the indication of metastatic pelvic lymph nodes by comparing data from preoperative lymphangiography, inspection of lymph nodes during laparotomy, radiography of surgically removed lymph nodes, and postoperative histologic report. Twenty-one patients (mean age 51.1 years, SD 14.5) with cervical cancer FIGO stages I b to II b were enrolled in this study. They all underwent Wertheim's radical hysterectomy with pelvic lymphadenectomy. With reference to histologic report this series included 8 squamous carcinomas (38%), 10 adenocarcinomas (48%) and 3 sarcomas (14%). Seven patients (33%) had a positive preoperative lymphangiography, in 9 patients (43%) lymph nodes were considered positive at the inspection during laparotomy, postoperative radiography of the lymph nodes was considered probably positive in 7 patients (33%) and positive in 2 patients (10%), histologic report was positive for lymphonodal metastases in 4 patients (19%). A total of 335 lymph nodes were studied, and with reference to the evaluated methods (lymphangiography, inspection, radiography, histology), 1 positive method was found in 40 lymph nodes (12%), 2 positive methods in 6 lymph nodes (2%), 3 or 4 positive methods in none of the lymph, nodes, and 4 negative methods in 289 lymph nodes (86%). Histologic report was positive in 4 lymph nodes (1%). Lymphangiography in the pretreatment evaluation in cases of cervical carcinoma is not reliable in indicating possible metastatic lymph nodes. It remains a useful exam fixation to be routinely performed.

Adult↗
PubMedDate not supplied

The radiography essentials: an evolutionary perspective.

A review of all the Radiography Essentials since their inception in 1944 provides an insightful look into the history and dynamics of entry-level educational standards in radiography. As successive Essentials have been revised, more attention has been given to the clinical environment, a broadened and strengthened curricula and due process. Additionally, radiographers have gained greater autonomy in delivering professional entry-level education in radiography.

Curriculum↗
PubMedDate not supplied

[The CR digital radiography system in traditional X-ray studies (according to the materials of the Moscow Regional Clinical Research Institute)].

The basic idea of the author's paper is to attempt to estimate and prove whether it is advisable to use the CR digital radiography system in a multidisciplinary therapeutic institution mainly at the municipal level. The pre-requisites for this were the results of diagnostic studies of different diseases of organs and systems. Emphasis is laid on the specific features of use of this digital system; namely, it can convert several analogue X-ray apparatuses to digital ones and it is more profitable than indirect image numeralization apparatuses and produces lower radiation loads. This all makes the use of these digital systems tempting in traditional X-ray study. A comparatively large material (4237 cases) was used to show the efficiency of the CR digital radiography system in the diagnosis of ENT diseases, osteology, interventional radiology, gastroenterology, pediatrics and to demonstrate a modernized approach to having a solid copy of a digital image, the possibilities of postprocessing that may enhance the validity of existing X-ray symptoms. This all allows the author to recommend that the CR digital radiography systems be used in traditional X-ray study for the diagnosis of various diseases occurring in a multidisciplinary health care facility mainly at municipal and regional levels.

Academies and Institutes↗
PubMed1991

[Roentgen diagnosis of pulmonary complications following allogeneic bone marrow transplantation--application of and experience with digital luminescence radiography].

Pulmonary complications exercise a decisive influence on the prognosis of leukaemia patients after bone marrow transplantation. Very early diagnosis is a mandatory prerequisite to successful therapeutic intervention. Of great importance besides the clinical findings and bronchoalveolar lavage is the analysis of the x-ray morphology of pneumonic infiltrates to narrow down the differential diagnostic spectrum. Since the patients are at high risk of infection, they are under isolated care, so that x-ray examinations can only be performed by means of projection radiography using mobile units. Due to these difficulties in performing relevant radiography the required optimal and constant image quality cannot be achieved by means of conventional x-ray film, so that very early detection of pulmonary complications is not always possible. The use of digital luminescence radiography (DLR) with luminescent storage foils enables a highly constant and hence comparable image quality thanks to increased image dynamics, a larger area of the examined object, and histogram evaluation of the image data for determining the optimal parameters for assessment. In addition, details can be better identified to supply answers to specific questions, because the image can be reprocessed to select relevant image parameters by monitoring. Pulmonary complications in 86 patients were analysed retrospectively. These patients had received an allogeneic bone marrow transplant for acute myeloic leukaemia, after they had been treated with high-dose radio-/chemotherapy. The x-ray morphology, clinical and sometimes autopsy findings were correlated with the occurrence of pulmonary complications subsequent to bone marrow transplant.

Adolescent↗
PubMed1990

Assessment of adjunctive flurbiprofen therapy in root-form implant healing with digital subtraction radiography.

The goals of these case reports were to (1) apply digital subtraction radiography to the assessment of the healing of root-form implants so that small changes in bone height and density could be detected and (2) to compare the bony support around root-form implants in patients prescribed the non-steroidal anti-inflammatory drug, flurbiprofen, with support in patients who did not receive the flurbiprofen as adjunctive therapy. Titanium root-form implants were surgically placed in four patients who were randomly assigned to receive either 100 mg flurbiprofen twice a day for three months or no flurbiprofen (as controls). Radiographs were taken immediately post-operatively and at four months. Digital subtraction radiography was used to detect sites of bone gain, loss, or unchanged bone around the implant. This four-month pilot study suggests that the non-steroidal anti-inflammatory drug, flurbiprofen, appears to be associated with increased bone density surrounding dental implants, and that digital subtraction radiography may be useful for the evaluation of bone density changes around dental implants.

Bone Density↗
PubMed1990

Dynamic imaging of pulmonary ventilation in children using digital subtraction radiography.

Digital subtraction radiography is a sensitive method for imaging changes in pulmonary aeration during the respiratory cycle. The findings of 75 consecutive dynamic pulmonary examinations performed on 49 pediatric patients using this technique were reviewed together with the findings at chest radiography and, in 18 cases, with bronchoscopy. Symmetric diaphragmatic movement and synchronous, homogeneous variation in the attenuation of lung parenchyma indicated normal conditions in 9 (18%) patients. The most common abnormal finding (36 patients) was an asynchronous variation in the attenuation of the lung parenchyma. A greatly diminished or absent variation in attenuation was diagnostic for a serious air passage obstruction in 7 children. Other abnormal findings were a lowered amplitude of diaphragmatic movement, asynchronous diaphragmatic movement and mediastinal shift. In 10 patients (20%) the dynamic study showed parenchymal abnormalities when chest radiography was normal. Bronchoscopy was performed in 4 of these 10 patients and showed abnormalities in each case.

Adolescent↗
PubMed1990

Assessment of survey radiography and comparison with x-ray computed tomography for detection of hyperfunctioning adrenocortical tumors in dogs.

Results of abdominal survey radiography and x-ray computed tomography (CT) were compared in 13 dogs with hyperadrenocorticism histologically attributed to adrenocortical tumors. X-ray computed tomography enabled accurate localization of the tumor in all 13 dogs. Apart from 2 poorly demarcated irregular-shaped and mineralized carcinomas, there were no differences between adenoma (n = 3) and carcinoma (n = 10) on CT images. In 1 dog, invasion of the caudal vena cava by the tumor was suggested on CT images and was confirmed during surgery. Suspicion of adhesions between tumors of the right adrenal gland and the caudal vena cava on the basis of CT images was confirmed during surgery in only 2 of 6 dogs. Survey radiography allowed accurate localization of the tumor in 7 dogs (4 on the right side and 3 on the left). In 6 of these dogs, the tumor was visible as a well-demarcated soft tissue mass and, in the other dog, as a poorly demarcated mineralized mass. The smallest tumor visualized on survey radiographs had a diameter of 20 mm on CT images. Six tumors with diameter less than or equal to 20 mm were not visualized on survey radiographs. In 1 of these dogs, a mineralized nodule was found in the left adrenal region, without evidence of a mass. In a considerable number of cases, survey radiography can provide presurgical localization of adrenocortical tumors in dogs with hyperadrenocorticism; CT is redundant in these instances. In the absence of positive radiographic findings, CT is valuable for localization of adrenocortical tumors.

Adenoma↗