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PubMed2004

Genetic damage in exfoliated cells from oral mucosa of individuals exposed to X-rays during panoramic dental radiographies.

The genotoxic effects of X-ray emitted during dental panoramic radiography were evaluated in exfoliated cells from oral epithelium through a differentiated protocol of the micronucleus test. Thirty-one healthy individuals agreed to participate in this study and were submitted to this procedure for diagnosis purpose after being requested by the dentist. All of them answered a questionnaire before the examination. Cells were obtained from both sides of the cheek by gentle scrapping with a cervical brush, immediately before the exposure and after 10 days. Cytological preparations were stained according to Feulgen-Rossenbeck reaction and analyzed under light and laser scanning confocal microscopies. Micronuclei, nuclear projections (buds and broken eggs) and degenerative nuclear alterations (condensed chromatin, karyolysis and karyorrhexis) were scored. The frequencies of micronuclei, karyolysis and pycnosis were similar before and after exposure (P > 0.90), whereas the condensation of the chromatin and the karyorrhexis increased significantly after exposure (P < 0.0001). In contrast, both bud and broken egg frequencies were significantly higher before the examination (P < 0.005), suggesting that these structures are associated to the normal epithelium differentiation. The results suggest that the X-ray exposure during panoramic dental radiography induces a cytotoxic effect by increasing apoptosis. We also believe that the score of other nuclear alterations in addition to the micronucleus improves the sensitivity of genotoxic effects detection.

Female↗
PubMed1992

Chest radiography for general practitioners: scope for change?

In order to derive guidelines for general practitioners on the value of chest radiography we prospectively reviewed all chest radiographs over a 10 month period. Radiographic chest examinations (frontal with or without a lateral view) were performed on 2017 patients in the radiology department or at the chest clinic. Patient details were noted, referring practice and waiting times monitored. The adequacy of the referral letter was assessed, and specific predetermined clinical findings were correlated with the radiographic findings. Results were divided into three groups (normal, abnormal with a clinically unrelated or chronic abnormality, and abnormal with a clinically related abnormality). Of these patients, 1245 (62%) had normal examinations and 460 (23%) had clinically related abnormalities. Abnormalities were rare in the 10-29 year age group, and when reassurance was sought for patients with symptoms of non-specific chest pain or general ill health. Patients presenting with haemoptysis or with symptoms of lower respiratory infection, or of chronic airways disease often had an abnormal radiograph. A clinical diagnosis was indicated or implied in 1664 (82%) and confirmed in 876 (53%). The most frequent reason for referral was for reassurance (618 patients). Guidelines based on age and symptoms should rationalize the use of chest radiography by general practitioners.

Adolescent↗
PubMed1990

Radiography of the paranasal sinuses--one or three views?

A prospective study of 100 adult patients undergoing paranasal sinus radiography was performed. Two experienced radiologists independently assessed a single occipitomental view and, at a later date, the traditional three projections, i.e. occipitomental, occipitofrontal and lateral. There was 99% intra-observer agreement between the diagnosis on a single projection compared with all three films. In five cases, the frontal sinuses were difficult to assess mainly due to poor radiography, and in defined circumstances additional views may be required occasionally. We conclude that with greater attention to radiographic technique the occipitomental view alone is sufficient for diagnostic purposes.

Adolescent↗
PubMed1994

The detection of foreign bodies in soft tissue--comparison of conventional and digital radiography.

The vast majority of glass and metallic foreign bodies can be detected with conventional radiography. The visibility of common woods and plastics is, however, unknown. To assess their radiographic visibility, various woods and plastics of equal size were inserted into fresh porcine tissue. The pork was then radiographed, under identical conditions, using conventional film-screen combination and a FUJI computed radiographic system utilizing its edge-enhancement facility. The visibility of the compounds was scored by four radiologists for both systems at various times post-insertion. Plastics were found to vary widely in visibility. Dried timbers were visible initially but became isodense with time due to absorption of fluid from surrounding tissues. Fresh woods were invisible from the outset. The computed radiographs improved the visibility of objects visible with conventional radiography but did not bring about visualization of those invisible to normal film-screen combinations. In conclusion the visibility of woods and plastics is variable. Some improvement in visibility can be brought about by the use of digitally edge-enhanced computed radiographs.

Adipose Tissue↗
PubMed1983

Flexion and extension radiography of the lumbar spine: a comparison with lumbar discography.

Four methods of quantifying relative intervertebral body movement from static flexion/extension radiographs are reviewed and the ability of each of these techniques to indicate the site(s) of disc degeneration is compared with that of lumbar discography. Of the methods examined, that of measuring the linear displacement of one vertebra in the antero-posterior plane was found to be the most accurate method of indicating disc degeneracy. None of the methods examined was free from artefacts. With regard to the clinical usefulness of flexion/extension radiography, we discuss two separate situations. Firstly, the taking of a single set of flexion/extension radiographs is concluded to be of little value in the management of patients with low back pain. Secondly, flexion/extension radiography, on a serial basis, is considered to be of possible value in specific situations (for example, follow-up of a spinal fusion).

Humans↗
PubMed1996

A comparison of ultrasound and plain radiography in the diagnosis of maxillary sinusitis.

The diagnosis of maxillary sinusitis can be difficult, with clinical signs and symptoms leading to a correct diagnosis in only approximately half of cases. This study compared ultrasound and plain radiography of 50 maxillary antra (25 patients) with clinically suspected maxillary sinusitis. Ultrasound showed 100% concordance with plain radiographs reported as normal, and was abnormal in all cases where plain films were reported as showing complete opacification or an air fluid level, the only reliable plain film indicators of an inflamed antrum. We conclude that ultrasound can provide an alternative to plain radiography in the initial investigation of maxillary sinusitis.

Humans↗
PubMed1996

High resolution radiography of cadaveric kidneys: unraveling the mystery of Randall's plaque formation.

PURPOSE: We used high resolution radiography to identify and characterize Randall's plaques in cadaveric kidneys. MATERIALS AND METHODS: A total of 50 consecutive sets of cadaveric kidneys was fixed, bivalved and imaged with micro-focal spot magnification radiography. Papillary calcifications were identified, localized and processed for light microscopy. Special immunohistochemical stains were implemented to aid localization of ectopic calcifications. Patient medical records and autopsy results were retrospectively evaluated and correlated with radiographic papillary calcifications. RESULTS: Of the 92 renal units with complete data 52 (57%) had radiographic evidence of renal medullary calcifications consistent with Randall's plaques. Unlike the original description of this condition, calcifications extended deep into the papilla. A history of hypertension was the only clinical parameter correlating with papillary calcifications. Calcium deposition was localized to the basement membrane of collecting tubules and vasa recta, and papillary interstitium. CONCLUSIONS: Randall's plaques are not merely subepithelial deposits. Rather, they appear to extend deep within the papilla, and are intimately associated with collecting tubules and vasa recta. An association between papillary calcifications and urinary stone formation has yet to be proved but is under investigation.

Cadaver↗
PubMed1975

Fine detail radiography in the examination of tissue.

The technique of fine detail radiography is presented with a discussion of its value to the pathologist. The current availability of safe equipment for fine detail radiography makes this technique highly useful in the examination of calcified tissues as well as a wide variety of soft tissues.

Bone Neoplasms↗
PubMed1991

Usefulness of empiric chest radiography and urinalysis testing in adults with acute sickle cell pain crisis.

STUDY OBJECTIVE: To determine the usefulness of obtaining routine chest radiographs and urinalyses on adults presenting to the emergency department in acute sickle cell pain crisis. The hypothesis tested is that in some adult sickle cell patients, sickle cell pain crises are precipitated or accompanied by acute infection that may be clinically occult and that routine screening for pulmonary or urinary tract infection would identify some of these precipitating illnesses. DESIGN: Prospective clinical study. SETTING: A university hospital ED. PATIENTS: All patients more than 14 years old with S-S, S-C, or S-beta-thalassemia sickle hemoglobinopathies who presented to the ED with acute nontraumatic painful complaints during a six-month period. INTERVENTIONS: All patients underwent posteroanterior and lateral chest radiography, routine urinalysis, and CBC count with reticulocyte count. A standard questionnaire for localizing symptoms of systemic, pulmonary, and urinary tract infection was completed for each patient. Urine cultures were ordered on all patients with voiding symptoms, flank pain, and/or more than 5 WBCs or RBCs per high-power field on urinalysis. Physical examination for evidence of pulmonary and urinary tract infection was carefully performed and recorded for subsequent analysis. RESULTS: Seventy-one patients with 134 ED presentations were studied over a six-month period. Eight diagnoses of acute pneumonia were made. Four of these patients complained of chest pain (50% vs 48% overall) and three had shortness of breath (38% vs 21%). None of these patients complained of fever or symptoms of upper respiratory illness. Ten diagnoses of urinary tract infection were made. Four of these patients complained of dysuria and frequency; three complained of flank pain. Eleven of the 18 infections (61.1%) did not have a typical history for or suggestive physical or laboratory findings of bacterial infection. CONCLUSION: In sickle cell disease patients with pain crisis, routine chest radiography and urinalysis may be clinically useful and cost effective in the early diagnosis of crisis-related infection.

Acute Disease↗
PubMed1993

Evaluation of high-yield criteria for chest radiography in acute exacerbation of chronic obstructive pulmonary disease.

STUDY OBJECTIVES: The objectives of this study were to assess the incidence of abnormal chest radiographs and to test the validity of previously developed high-yield criteria. There is disagreement about the need for chest radiography in acute exacerbation of chronic obstructive pulmonary disease, although high-yield criteria have been developed. DESIGN: Retrospective chart review study. SETTING: County-owned, university-affiliated, urban emergency department. PARTICIPANTS: ED patients seen between January 1988 and July 1991 with chronic obstructive pulmonary disease. RESULTS: Eight hundred forty-seven ED visits were identified; medical records were available for 742. Radiographs were not taken in 8%, leaving 685 ED visits in the study. One hundred nine patients (16%) had significant abnormalities, including 88 new infiltrates, two new lung masses, one pneumothorax, and 20 episodes of pulmonary edema. A history of congestive heart failure and fever was associated with abnormalities, as were findings of rales, pedal edema, and jugular venous distension. There was no association with WBC count, temperature, coronary artery disease, chest pain, or sputum production. Previously published high-yield criteria had a sensitivity of .76; specificity, .41; positive predictive value, 20; negative predictive value, .90; and accuracy, .47. CONCLUSION: Radiographic abnormalities are common findings in acute exacerbation of chronic obstructive pulmonary disease. We found that almost one fourth of radiographic abnormalities are not predictable on the basis of previously developed high-yield criteria. Routine chest radiography should be considered in patients with acute exacerbation of chronic obstructive pulmonary disease to diagnose treatable, radiographically apparent abnormalities.

Aged↗
PubMed1992

A study to develop clinical decision rules for the use of radiography in acute ankle injuries.

STUDY OBJECTIVE: To develop decision rules that will predict fractures in patients with ankle injuries, thereby assisting clinicians in being more selective in their use of radiography. DESIGN: Prospective survey of emergency department patients over a five-month period. SETTING: Two university hospital EDs. PARTICIPANTS: One hundred fifty-five adults in a pilot stage and 750 in the main study; all presented with acute blunt ankle injuries. INTERVENTIONS: Thirty-two standardized clinical variables were assessed and recorded on data sheets by staff emergency physicians before radiography. MEASUREMENTS: Variables were assessed for reliability by the kappa coefficient and for association with significant fracture on both ankle and foot radiographic series by univariate analysis. The data then were analyzed by logistic regression and recursive partitioning techniques to develop decision rules for predicting fractures in each radiographic series. MAIN RESULTS: All 70 significant malleolar fractures found in the 689 ankle radiographic series performed were identified among people who had pain near the malleoli and were age 55 years or more, had localized bone tenderness of the posterior edge or tip of either malleolus, or were unable to bear weight both immediately after the injury and in the ED. This rule was 100% sensitive and 40.1% specific for detecting malleolar fractures and would allow a reduction of 36.0% of ankle radiographic series ordered. Similarly, all 32 significant midfoot fractures on the 230 foot radiographic series performed were found among patients with pain in the midfoot and bone tenderness at the base of the fifth metatarsal, the cuboid, or the navicular. CONCLUSION: Highly sensitive decision rules have been developed and will now be validated; these may permit clinicians to confidently reduce the number of radiographs ordered in patients with ankle injuries.

Adult↗
PubMed1989

Exposure of emergency medicine personnel to ionizing radiation during cervical spine radiography.

We studied the potential hazard of ionizing radiation exposure to health care workers who routinely stabilize the necks of trauma patients during cervical spine radiography. A clinical trauma model was developed using an Alderson RANDO Phantom artificial torso to simulate an actual patient. A radiation monitor was placed where a health care worker's fingers, hands, arms, and thyroid gland would be, and standard cervical spine radiographs were taken. The exposures to the finger positions then were repeated with the monitor inside a 0.5 mm lead-equivalent glove. The mean exposure to the finger for a single cross-table lateral radiograph was 174.5 mrem. The use of leaded gloves reduced this exposure to 0.3 mrem a 99.9% reduction). For a single series of lateral, anteroposterior, odontoid, and swimmer's views, the total mean measured unprotected exposure to the finger of the hand positioned nearest the radiographic tube was 681 mrem and the exposure to the finger of the opposite hand was 230 mrem. If these simulated exposures are indicative of actual patient situations, a health care worker who holds the head of a trauma patient four times each week with unshielded hands would receive more than twice the maximum allowable annual occupational radiation exposure to the extremities recommended by the National Council of Radiation Protection and Measurements. We conclude that health care workers who routinely stabilize the necks of trauma patients during cervical spine radiography may incur a radiation exposure risk and that 0.5-mm lead-equivalent gloves provide an effective barrier to ionizing radiation.

Cervical Vertebrae↗
PubMed1997

Occult fractures of the scaphoid. The diagnostic usefulness and indirect economic repercussions of radiography versus magnetic resonance scanning.

Scaphoid fractures that are not visible on initial radiographs are notoriously difficult to diagnose. This prospective study compared four-view plain radiography at an average of 14 days after injury, with high-definition macroradiography and magnetic resonance imaging at presentation. Initial magnetic resonance imaging was superior to repeat scaphoid radiography for the confirmation or exclusion of fractures as well as for the detection of associated wrist injuries. Macroradiography was unsuitable for screening for occult scaphoid fractures.

Adolescent↗
PubMed1977

Value and limitation of panoramic radiography in the diagnosis of maxillary sinus pathosis.

Panoramic radiography is superior to the Water's projection for the detection of maxillary sinus malignancy and cyst-like lesions near the floor of the maxillary sinus. Panoramic radiography is, however, not a technique for the examination of cloudiness, and thickening of the mucous membrane of the maxillary sinus, and bony sclerosis of the maxilla associated with maxillary sinusitis. The two techniques supplement each other in the diagnosis of maxillary sinus pathosis.

Evaluation Studies as Topic↗
PubMed1997

Evaluation of permanent I-125 prostate implants using radiography and magnetic resonance imaging.

PURPOSE: The aim of this study is the evaluation of permanent I-125 prostate implants using radiography and magnetic resonance imaging (MRI). METHODS AND MATERIALS: Twenty-one patients underwent radiography on the simulator and MRI within 3 days after implantation of the I-125 seeds. Isocentric radiographs were used for reconstruction of the seed distribution, after which registration with the seed-induced signal voids on MRI provided the seed positions in relation to the prostate. The prostate was contoured on the transversal magnetic resonance images, and dose-volume histograms were computed to evaluate the implants. The validity of the ellipsoidal prostate volume approximation, as applied in preimplant dose calculation, was assessed by comparison of ellipsoidal volumes given by prostate width, height, and length and prostate volumes obtained by a slice-by-slice contouring method, both on postimplant MRI. Prostate volume changes due to postimplant prostate swelling were assessed from radiographs taken at 3 days and 1 month after the implantation. RESULTS: The seeds were readily identified on T1-weighted spin-echo images and matched with the seed distribution reconstructed from the isocentric radiographs. The matching error, averaged over 21 patients, amounted to 1.8 +/- 0.4 mm (mean +/- standard deviation). The fractions of the prostate volumes receiving the prescribed matched peripheral dose (MPD) ranged from 32 to 71% (mean +/- standard deviation: 60 +/- 10%). Prostate volumes, obtained by the contouring method on postimplant MRI, were a factor 1.5 +/- 0.3 larger than the ellipsoidal volumes given by the prostate dimensions on postimplant MRI. Prostate volumes 3 days after the implantation were a factor 1.3 +/- 0.2 larger than the prostate volumes 1 month after the implantation. Registration of the reconstructed seed distribution and the MR images showed inaccuracies in seed placement, for example, two or more seeds clustering together or seeds outside the prostate. CONCLUSIONS: Registration of the reconstructed seed distribution and the MR images enabled evaluation of target coverage, which amounted to 60 +/- 10%. The discrepancy between prescribed dose and realized dose was caused by underestimation of the preimplant prostate volume due to the ellipsoidal approximation, postimplant prostate swelling at the time of evaluation, and inaccuracies in seed placement.

Brachytherapy↗
PubMed1979

Comparative evaluation of the effect of a high yield criteria list upon skull radiography.

Based on results of studies using high yield criteria to determine the need for skull radiography, the Utilization Review Committee of the University Hospital (UH), University of Washington, Seattle implemented a policy encouraging use of the criteria in ordering skull radiology. The Bureau of Radiologic Health of the FDA supported a project comparing skull radiology use patterns at UH, with the high yield criteria policy, and Harborview Medical Center (HMC), without a policy. Results showed an increase of around 60% at HMC since the 1972--73 academic year. At UH, there was a decrease of 40% since the 1972--73 academic year. At HMC a medical record review showed only 51 positive reports that significantly contributed to patient care, about the same rate observed in 1967. At the UH, only nine positive reports significantly contributed to patient care, with 62% compliance with the high yield criteria. A current demonstration project under the auspices of the Washington State Professional Standards Review Organization and Bureau of Radiologic Health involves implementing the high yield criteria list at both HMC and UH. After three months, out of 6,003 patient visits, skull radiography was deemed necessary in 518 cases. Of this total 181 had high yield criteria checked. There were 37 positive reports out of these and 23 examinations that made a documented significant contribution to patient care. In the group without high yield criteria, 434 cases, there were 22 positive reports but no significant contribution to patient care documented after four weeks.

Craniocerebral Trauma↗
PubMed2000

Digital selenium radiography: detection of subtle pulmonary lesions on images acquired with and without an additional antiscatter grid.

OBJECTIVE: the objective of this ROC-study was to evaluate the diagnostic efficacy of images acquired with a grid in digital selenium radiography compared to that on images obtained with the integrated air gap only. MATERIALS AND METHODS: seven types of simulated lesions were superimposed onto an anthropomorphic chest phantom. Selenium radiography images were obtained either with or without an additional antiscatter grid. For images acquired with a grid either a similar or increased exposure level was used. Both normal and obese patients were simulated. RESULTS: When a grid was used with an equivalent detector dose and a higher exposure, diagnostic performance was significantly improved as compared to images obtained with only the air gap. ROC curve areas for mediastinal nodules and catheters were substantially higher for images acquired with a grid and the same exposure level compared to images obtained without a grid. However, detection of linear, net-shaped and reticulonodular structures in peripheral lung regions was significantly worse when a grid was used with an equivalent exposure level. Concerning the interpretation of images obtained from the normal and obese phantom models, no substantial differences were observed. CONCLUSION: a marked improvement in diagnostic performance could be achieved by means of the use of an additional antiscatter grid and an equivalent detector dose. However, when the same exposure was used, images acquired with the grid allowed a better detection of mediastinal structures although a worse performance was evident in radiolucent lung regions. Therefore, the routine use of a grid without increased exposure is not recommended.

Humans↗
PubMed1999

Plain abdominal radiography in clinically suspected appendicitis: diagnostic yield, resource use, and comparison with CT.

This study determined the diagnostic utility and hospital resource impact of plain abdominal radiography in emergency department patients with suspected appendicitis. The authors reviewed medical records of 821 consecutive patients hospitalized for suspected appendicitis; 78% had plain abdominal radiography. Sixty-four percent had appendicitis. Radiographic findings were noted in 51% of patients with, and 47% of patients without appendicitis; no individual radiographic finding was sensitive or specific. Specific conditions were suggested in 10% of impressions; these failed to correlate with final clinical diagnoses 57% of the time. Hospital cost per abdominal radiograph was $67; cost per specific, correct radiographic diagnosis was $1,593. This is compared with $270 per appendiceal computed tomography scan (based on recent literature data). The authors conclude that plain abdominal radiographs in patients with suspected appendicitis are neither sensitive nor specific, are frequently misleading, are costly per specific and correct diagnosis, and should not be routinely obtained on patients with suspected appendicitis.

Adolescent↗