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PubMed1991

The value of portable chest roentgenography in adult respiratory distress syndrome. Comparison with computed tomography.

In 17 patients with adult respiratory distress syndrome, we used data derived from computed tomographic (CT) scan densitometric analysis to validate the value of portable chest roentgenograms in objectively estimating the amount of pulmonary edema. Chest roentgenograms and CT scans were taken in the same ventilatory conditions (apnea at 10 cm H2O of positive end-expiratory pressure [PEEP]); blood gas samples and hemodynamic parameters were collected at the same time. Roentgenographic analysis was undertaken by independent observers using two standardized scoring systems proposed in the literature. CT scan analysis was performed using the CT number frequency distribution and the gas lung volume (measured by helium dilution technique) to estimate quantitatively the lung density, the lung weight, and the percentage of normally aerated and nonaerated tissue. Knowing the mean CT number of the pulmonary parenchyma in a group of normal subjects, we also inferred the ideal lung weight expected in the study population and computed the excess tissue mass as the difference between actual and ideal lung weight. Both the roentgenographic scoring systems showed direct correlation with the pulmonary impairment as detected by CT scan densitometric analysis (CT number, percentage of nonaerated tissue, lung weight, and excess tissue mass; p less than 0.01) and inverse relation with the percentage of normally aerated tissue (p less than 0.01). We also found a relationship between roentgenographic scores and the impairment in gas exchange as detected by shunt fraction (p less than 0.05). We conclude that standardized reading of portable chest roentgenograms by means of scoring tables is a valuable tool in estimating the amount of pulmonary edema in a patient with adult respiratory distress syndrome.

Absorptiometry, Photon↗
PubMed1992

The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia.

An abnormal chest roentgenogram is essential for the diagnosis of ventilator-associated pneumonia. The diagnostic accuracy of various roentgenographic signs of pneumonia has not been assessed previously in the portable anteroposterior roentgenograms obtained in ventilated patients. Seven roentgenographic signs (air bronchograms, alveolar infiltrates, silhouette sign, cavities, fissure abutment, atelectasis, and asymmetric infiltrates superimposed on diffuse bilateral infiltrates) were evaluated for their accuracy in predicting pneumonia alone, in combination with other signs, or in combination with clinical parameters. The last roentgenogram prior to autopsy of 69 ventilated patients was interpreted by three reviewers and the above signs were correlated with autopsy evidence of pneumonia. Pneumonia was present in 24 (35 percent) of the 69 autopsies. No roentgenographic sign had a diagnostic efficiency of greater than 68 percent. By stepwise logistic regression, the presence of air bronchograms was the only roentgenographic sign that correlated with pneumonia in the total group, correctly predicting 64 percent of pneumonias. In patients without adult respiratory distress syndrome (ARDS), the presence of air bronchograms or alveolar infiltrates correlated with pneumonia, while in patients with ARDS, no roentgenographic sign and only the clinical parameter of purulent sputum correlated with pneumonia. Only a minority (7/22) of worsening alveolar infiltrates in all groups were due to pneumonia and were often confused with ARDS. Alveolar hemorrhage occurred with a surprising frequency (38 percent of autopsies), including 13/45 (29 percent) patients without pneumonia. Alveolar hemorrhage was associated with 29 percent of multiple air bronchograms and 30 percent of bilateral alveolar infiltrates in patients without pneumonia. We conclude that in intubated patients with diffuse bilateral roentgenographic infiltrates, no roentgenographic sign correlates well with pneumonia. No clinical parameter added to the accuracy of either an alveolar infiltrate or an air bronchogram in patients without diffuse infiltrates. Pulmonary hemorrhage and/or infarction are frequent autopsy findings in intubated patients and may be confused radiologically with pneumonia.

Autopsy↗
PubMed1982

Significance of roentgenographic abnormalities in children hospitalized for asthma.

The relatively high incidence of roentgenographic abnormalities in patients hospitalized for acute asthma has led some to recommend that all such patients receive chest x-ray examination upon admission to the hospital. We studied the incidence and clinical predictability of the roentgenographic findings by asking the admitting physician to indicate, prior to obtaining a roentgenogram, whether he thought pneumonia, pneumothorax, pneumomediastinum or other significant abnormality was present. A treatment plan was also outlined at that time. Seven of 128 patients (5.5 percent) had roentgenograms suggestive of pneumonia or pneumothorax; three of these were suspected clinically. In 14 cases the clinical suspicion of pneumonia or pneumothorax was not borne out roentgenographically. The initial treatment plan was altered in only three cases. The low incidence of roentgenographic abnormalities and the failure of these minor abnormalities to substantially influence treatment suggest that routine chest roentgenograms may not have to be performed on all children hospitalized for acute asthma.

Adolescent↗
PubMed1983

Pulmonary function in progressive systemic sclerosis. Comparison of CREST syndrome variant with diffuse scleroderma.

The pulmonary function and chest roentgenograms were evaluated in 88 patients with the CREST syndrome variant of progressive systemic sclerosis (PSS or scleroderma). Seventy-two percent of the patients had abnormal pulmonary function. An isolated decrease in diffusing capacity was the most common abnormality noted, followed by restrictive abnormalities and airway obstruction. Chest roentgenograms revealed interstitial infiltrates consistent with pulmonary fibrosis in 33 percent. When compared to a contemporaneous group of 77 patients with PSS and diffuse scleroderma, patients with the CREST syndrome had similar abnormalities on pulmonary function testing and chest roentgenogram. However, patients with the CREST syndrome had a lower mean diffusing capacity despite a higher mean vital capacity; this combination of findings suggests primary pulmonary vascular disease. Calcified granulomata were identified significantly more often in PSS-CREST patients, while superior rib notching occurred exclusively in patients with PSS and diffuse scleroderma. The CREST variant of PSS is associated with frequent roentgenographic and pulmonary function abnormalities similar to those seen in PSS with diffuse scleroderma.

Adult↗
PubMed1990

Predictive value of bronchoalveolar lavage in pulmonary sarcoidosis.

We investigated whether analysis of cellular composition (including lymphocyte subsets) in bronchoalveolar lavage (BAL) fluid at the start of follow-up in patients with untreated sarcoidosis has any predictive value for further evolution of the disease. The outcome was evaluated by the chest roentgenograms, the lung volumes, and the single breath diffusing capacity for CO (DCO) after 22 to 36 months. In contrast to the general belief, patients who improved radiologically had a significantly higher T4 cell count (as percentage of BAL lymphocytes) (p less than 0.02) and a higher T4-T8 ratio in the initial BAL sample (9.3 vs 3.2; p less than 0.05) than those whose chest roentgenogram showed deterioration or remained unchanged. Total cell count and the percentage of lymphocytes in BAL fluid were not different between both groups. The change in DCO at the end of the follow-up period correlated positively with the baseline BAL T4 cells (Rs = 0.44; p less than 0.05) and with the BAL T4-T8 ratio (Rs = 0.51; p less than 0.03) and negatively with the baseline BAL T8 cells (Rs = -0.48; p less than 0.04). In only three patients progression of the disease necessitated steroid therapy, and they all had a low to normal T4-T8 ratio in the initial BAL sample. Bronchoalveolar lavage was repeated at least once in ten patients. Improvement of the chest roentgenograms in these patients was accompanied by a decrease of the BAL T4 cell count (as percentage of lymphocytes) and of the T4-T8 ratio. We conclude that a high lymphocyte count, a high T4 cell count (as percentage of lymphocytes), and a high T4-T8 ratio in BAL fluid reflect an intense alveolitis at the time of the procedure, but they are not indicators of poor prognosis on which therapeutic decisions can be based.

Bronchoalveolar Lavage Fluid↗
PubMed2002

Extravascular collection of fluid around the vertebra resulting from malpositioning of a peripherally inserted central venous catheter in extremely low birth weight infants.

Peripherally inserted central venous catheters (PICCs) have allowed central venous access via peripheral veins for a long period. PICCs have become an indispensable tool in neonatal medicine. Despite their benefits, PICCs involve some risks, which include infection, thrombosis, malpositioning, and extravascular collection of fluid. We presented two patients with extravascular collection of fluid around the vertebra resulting from malpositioning of PICCs. The PICCs were placed via the saphenous veins in both patients. The PICCs were judged to be centrally placed in the inferior vena cava by means of supine abdominal roentgenograms. The next day one patient exhibited frequent apneic attacks and the other exhibited twitching movements. A lumbar puncture revealed extravascular collection of fluid around the vertebra. In lateral view chest-abdominal roentgenograms, the PICC tips were observed to be in the vertebral lumen. The PICCs were removed immediately and the condition of the patients improved. We stressed the usefulness of the lateral view abdominal roentgenograms for revealing the malpositioning of PICCs in the inferior vena cava.

Adult↗
PubMed1995

Osteonecrosis of the medial part of the tibial plateau.

Fifteen elderly patients (sixteen knees) were seen because of acute pain in the knee and tenderness to palpation over the medial aspect of the tibial plateau. Initially, plain roentgenograms showed a radiolucent area at the site of the tenderness in only nine of the sixteen knees. However, radionuclide bone scans showed focal increased uptake at the site of the tenderness in four of the seven remaining knees, and magnetic resonance images showed discrete areas of low signal intensity at the same site in the other three knees. Plain roentgenograms eventually showed the typical lesion in all knees. Progression of the symptoms led to a total knee arthroplasty in nine knees and to a unicompartmental replacement in three; a satisfactory result was obtained in all twelve knees. An operation was recommended for two other knees, but it was refused by the patients. The symptoms resolved spontaneously in the remaining two knees. A degenerative tear in the medial meniscus, which is a common finding in this age-group, was noted at the time of a later operation in the three knees that had not had a radiolucent area on the initial plain roentgenograms but that had had an area of low signal intensity on the magnetic resonance images. If osteonecrosis of the tibial plateau is not considered as a potential cause of pain in the knee, symptoms may be attributed to a tear in the meniscus and an unnecessary and unproductive arthroscopy may be performed.

Aged↗
PubMed1998

Legg-Calvé-Perthes disease in girls. A comparison of the results with those seen in boys.

We reviewed the records and roentgenograms of all patients with Legg-Calvé-Perthes disease who had been seen at our institution between 1940 and 1996. One hundred and five girls (122 hips) and 470 boys (531 hips) were identified. Thus, 18 per cent of the 575 patients in the present series were girls. Seventeen (16 per cent) of the girls and sixty-one (13 per cent) of the boys had bilateral involvement. Although more girls than boys had severe involvement of the femoral head and the lateral pillar, we could not detect a significant difference between the two groups with respect to the distribution of the involvement of the hips according to the system of Catterall or the lateral pillar classification (p > 0.05, beta = 0.99). Serial roentgenograms that showed all four stages of the disease according to the system of Waldenström were available for fifty-two hips in girls and 184 hips in boys. A review of these roentgenograms revealed that the average ages of the girls at the stages of necrosis, fragmentation, reossification, and remodeling were 6.8, 7.3, 7.9, and 9.5 years, respectively, whereas the average ages of the boys were 6.8, 7.3, 7.9, and 9.9 years, respectively. Girls, however, had closure of the affected proximal femoral physis at an average age of 12.9 years, whereas boys had closure at an average age of 15.8 years. Therefore, girls had a shorter potential period for remodeling of the femoral head (average, 3.4 years) compared with boys (average, 5.9 years). Sixty-four girls (seventy-eight hips) and 363 boys (416 hips) had reached skeletal maturity by the time of the latest follow-up and were evaluated according to the system of Stulberg et al.; we could not detect a significant difference between boys and girls with respect to the distribution of the hips according to this system (p > 0.05, beta = 0.99). Although the numbers were too small for statistical analysis, our findings suggest that boys and girls who have the same Catterall or lateral pillar classification at the time of the initial evaluation can be expected to have similar outcomes according to the classification system of Stulberg et al.

Adolescent↗
PubMed1998

Chest roentgenography after outpatient thoracentesis.

OBJECTIVE: To evaluate the clinical utility of posteroanterior chest roentgenograms after thoracentesis in the outpatient setting. DESIGN: We undertook a retrospective study of clinical records of outpatient thoracentesis performed between January and December 1996 by the Division of Pulmonary and Critical Care Medicine at Mayo Clinical Rochester. MATERIAL AND METHODS: The medical records of 54 men and 39 women who underwent 123 outpatient thoracentesis were reviewed. Exclusion criteria were the need for pleural biopsy at time of thoracentesis or the need for ultrasound-guided assistance for completion of the procedure. Indications for thoracentesis and postthoracentesis chest roentgenography were analyzed. RESULTS: Of 123 thoracentesis performed in the outpatient setting during the specified study period, 104 met the inclusion criteria. Of these 104 thoracentesis, 54 (52%) were followed by chest roentgenography. Pneumothorax occurred in only 5 of these 104 procedures (5%), in 5 separate patients. Three of these patients were asymptomatic and did not require therapeutic intervention; the two symptomatic patients required hospitalization and chest tube drainage. Of the two pneumothoraces in patients with symptoms, one was detected on the same day as the thoracentesis, and the other was diagnosed 2 days later. The patients who did not undergo postthoracentesis chest roentgenography had no reported complications. Of the 54 chest roentgenograms, 52 were obtained in asymptomatic patients, with no suspicion of pneumothorax. These x-ray studies led to a total cost of $4,862 and detection of three pneumothoraces that did not require therapy. CONCLUSION: Routine performance of chest roentgenography after outpatient thoracentesis can incur substantial cost. A more selective approach to this practice is needed, both to optimize patient care and to manage limited medical resources efficiently. Postthoracentesis chest roentgenograms should be limited to patients with symptoms indicative of thoracentesis-induced pneumothorax.

Aged↗
PubMed1993

[Cutaneous or subcutaneous calcinosis observed in leprosy patients. 1. Clinical observations].

A roentgenographic examination was made for the limbs of leprosy patients with calcinosis in whom atrophic cutaneous sclerosis and subcutaneous induration or infiltration were observed. The observation results are summarized as follows. 1. Atrophic cutaneous sclerosis was one of a sequela in lepromatous lesion, especially in case of ENL, and it was observed to occur frequently at the extended sides of 1/3distal part from the forearm and the crus mainly. The atrophied cutaneous surface was tinged with lustrous red. It was able to observe calcium deposition directly just under the skin and/or in the shallow subcutaneous region from the roentgenogram of the site. The roentgenographic patterns were demonstrated as if many granules were scattered, and also the dendric and reticular platy-expansions were detected in some cases. The enucleated parts seemed to be similar to the cancellous bone. It might be said that dystrophic calcinosis cutis developed by inducing histological disorder is one of the origin of such a calcinosis, because the skin in these regions is deficient in the mobility and tends to provoke the circulatory disorder in case of chronic inflammation as discerned in lepromatous lesion. 2. An induration in subcutaneous tissue is lipid lump being as it was when chaulmoogra oil was injected and not undergo absorption of the oil. The lipid lumps enveloped in the tunic were observed in the site of lateral upperarm and the front of femur. They seemed to be remained almost all as it was. It was observed that the lipid lumps, as such, were adjacent to the outer layer of fascia, but not in the muscle. And there are some cases where the oil flowed from the injection site through the hypodermis and got the lipid lumps formed in the forearm and/or the crus. Roentgenogram of that showed the existence of calcinosis regardless of size which transmissivity of X-ray had an irregular pattern. The enucleated lipid lumps were easily cut to pieces by scalpel. 3. It may be said that the calcinosis observed in atrophic cutaneous sclerosis due to lepromatous lesion or lipid lump of unabsorbed chaulmoogra oil makes it necessary for its healing to be 10-20 years. 4. Roentgenogram at that time revealed no abnormality as to serum calcium, phosphorous and/or alkaline phosphatase values.

Adult↗
PubMed1978

Endogenous activation in blastomycosis.

Recent work established the fact that the portal of entry in blastomycosis is the lung. After the initial exposure to the fungus, a pneumonic process develops that may heal spontaneously or progress locally or at distant sites, or both. Frequently, however, patients present with disseminated disease, whose chest roentgenograms do not show any lesions. We have recently seen three patients with disseminated blastomycosis with negative chest roentgenograms at the time of diagnosis. Past history showed a pneumonic illness 33, 32, and 4 months before diagnosis. Chest roentgenograms from the time of the original illness showed a pneumonic process compatible with blastomycosis in all three. Examination of postbronchoscopy sputa showed the characteristic yeasts of Blastomyces dermatitidis. These three patients document for the first time apparent endogenous activation in blastomycosis. A possible explanation for this apparent endogenous activation may reside in the histopathologic similarity between blastomycosis and other chronic granulomatous diseases, especially tuberculosis.

Adolescent↗
PubMed1992

Anatomic and functional assessment of stenosis severity with intravascular ultrasound imaging in vitro.

An in vitro study was performed to evaluate the accuracy of intravascular ultrasound imaging compared with roentgenography for determining the cross-sectional area of a lumen; and to determine if the functional significance of an irregular stenosis is predicted more accurately by intravascular ultrasound than roentgenography. Varying degrees of stenosis were made in 17 rubber tubings by adjusting a plastic constrictor. The cross-sectional areas at the normal and the stenotic segments were determined by intravascular ultrasound, roentgenography, and then measured directly from an acrylamide gel cast of the lumen. To evaluate the functional significance of a stenosis, the pressure drop across the stenosis was measured using a fluid pumping circuit. The actual pressure drop was then compared with the predicted pressure drop derived from hydrodynamic equations using cross-sectional areas obtained by intravascular ultrasound or roentgenography. There was an excellent correlation between the cross-sectional areas at the tightest stenosis measured by intravascular ultrasound compared with the area from the acrylamide cast (7.2 +/- 2.6 v 6.6 +/- 2.4 mm 2, mean +/- SD, r = .93). Measurements of cross-sectional area from the roentgenograms (10.9 +/- 3.9 mm 2) also provided a relatively good correlation with those from the acrylamide casts (r = .84); however, the roentgenograms consistently overestimated the cross-sectional area of the stenosis. The mean values of the actual pressure drop and the predicted pressure drop by intravascular ultrasound and roentgenograms were 15.7 +/- 13.5, 11.3 +/- 11.9, and 4.3 +/- 4.5 mmHg, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1976

[Classification and diagnosis of ankle injuries].

A new method for the classification of the injuries of the ankle is recommended by the author. The main types according to his classifixation are the following: pronation-flexion, pronation-extension, supination-extension, supination-flexion and supination-extension types. His classification is compared with Lauge-Hansen's and Weber's classification. Critical analysis of these two last classifications is given. The aim of the author's classification is to render help to the doctors for their every-days' curative work. The characteristic symptoms of the pronation and supination, resp., injuries are described. Attention is drawn to "Weber's lace"--this denomination is proposed by the author, since the first description is due to Weber. On the basis of the author's examinations described in his candidate's dissertation "syndesmolysis trigonum"--pathognostic for syndesmolysis--is dealt with. The "reclined" roentgenograms are dealt with. The so-called pronation reclined roentgenogram visualize the rupture of the deltoid ligament and the syndesmolysis in the same time. The sagittal reclined roentgenogram is dealth with separately, by means of which the "table-drawer" symptom may be produced.

Ankle Injuries↗
PubMedDate not supplied

[Incidence and severity of degenerative changes in the wrist in pseudoarthrosis of the scaphoid bone]].

INTRODUCTION: In patients with symptomatic scaphoid nonunion there was an increased evidence of progressive osteoarthrosis expressed as instability of the wrist [1, 2]; it is defined as a scapholunate angle of more than 70 degrees or a radiolunate angle of more than 10 degrees. Intercarpal instability causes unnatural joint movement of the wrist. This disorganization of the wrist mechanism associated with hypermobility of the schapoid bone induces degenerative changes [3]. Arthritic changes begin at the distal scaphoid-radial styloid joint and later progress to the capitolunate joint. A similarity was noted with rotatory instability of the scaphoid bone associated without fracture [2]. If mid-carpal joint exists the joint becomes unstable, the lunate rotates backwards and carpal bones show the so-called concertina deformity [4] or dorsal intercalated segment instability pattern [5]. AIM: We tried to determine the factors of risk and prognostic indicators of degenerative arthritis. METHOD: In this study 40 patients with painful nonunion of the scaphoid bone were analysed. Duration of nonunion was 1.43 year (range from 8 months to 15 years). Roentgenograms of the hand were done in anteroposterior, lateral and oblique projections. Fracture location and configuration were determined as described by Russe. Instability was determined by measuring the scapholunate and radiolunate angle in the lateral roentgenogram. Scapholunate angle more than 70 degrees and radiolunate angle more than 10 degrees were considered abnormal. To asses the amount of carpal collapse the carpal index was determined as described by Youm [6]. Abnormal value was 0.50 or less (normal value: 0.54 +/- 0.03). Four roentgenographic groups were established based on the extent of degenerative changes [7]. Group I showed no sign of degenerative changes. Group II had sclerotic lesions in fracture margins with or without a cystic formation. Group III showed lesions of radioscaphoid arthritis, including joint-space narrowing and pointing the radial styloid. Group IV had lesions of generalized arthritis of the wrist. RESULTS: Duration of nonunion was not in correlation with development of osteoarthritic changes (p = 0.644, p > 0.05) (Table 1). Progressive degenerative changes correlated well with radiolunate angle (p = 0.398, p < 0.05), capitolunate angle (p = 0.381, p < 0.05) and carpal index (p = 0.392, p < 0.05) (Table 2). The average values of intercarpal angles increased with progression of osteoarthritic changes (Table 3). There were 14 (35%) proximal third located fractures and 26 (65%) in the middle third or waist. There was a statistically strong correlation between location of the fracture in proximal third and presence of degenerative changes (p = 0.341, p < 0.01) (Table 4). Intensity of arthritic changes showed no statistically significant correlation regarding untreated fractures (p = 0.665, p > 0.05). DISCUSSION: In our study the most significant factors associated with arthritis were instability of the wrist and fracture location at the proximal third of the scaphoid bone. Mack [7] reviewed forty-seven symptomatic nonunions of the scaphoid and found a correlation between the presence of arthritis and the duration of nonunion. Also, he concluded that instability of the wrist can occur as late phenomenon in previously stable nonunion. Similar results were noted by Ruby [8] in his series. Conclusion of these authors was that the incidence of degenerative changes increased with the time after fracture of the scaphoid bone occurred [8-12]. We demonstrated that in untreated fractures associated with carpal instability, arthritis developed much earlier. Fourteen (35%) patients in our study were not treated and 92.8% belonged to Group II and Group III, with average time of nonunion duration of 27.2 months. Lunate dorsiflexion is a useful guide to carpal instability. In our experience the lunate silhouette is easily visualized on a lateral roentgenogram even in the presence of degenerative arthritis. There is a high probability that degenerative changes will occur. We recommend that a scaphoid nonunion associated with carpal instability should be operated before degenerative changes develop.

Disease Progression↗
PubMed2003

Description of diffuse interstitial lung diseases and assessment of their activity.

Conventional roentgenograms constitute the groundwork for the evaluation of diffuse interstitial lung disease (DILD). ILO classification with its symbols (additionally extended to granulomatoses) does not comprise pathoanatomic assumptions and does not enter lesion genesis for it could lead to diagnostic misconception. "High resolution" computer tomography (HRCT) provides the evaluation of lesion morphology and disease activity. After having treated our 129 patients with diffuse interstitial lung disease we have come to the conclusion that, beside pneumoconiosis, the application of extended standard ILO symbols are suitable to other interstitial pathology for the homogeneity of morphologic characteristics. As for diagnoses making, in distinction to other methods, it can be said that analyzing roentgenograms of the extended ILO provides high level of lesion evaluation standardization for diffuse interstitial disease as well as substantial congruity with CT finding. It is clear that such analysis cannot be applied in our daily work, however we have both concluded and proved that on conventional roentgenograms the condition of interstitial lesion can roughly be assessed. This is of high importance considering minimal dose of radiation exposure by standard tests in comparison with other radiological techniques. Nevertheless, CT scanning should be performed if there should be the need for the assessment of the morphology and the activity of lesion, to the benefit of our patients.

Adult↗
PubMed1992

[Value and limits of tomodensitometry applied to the diagnosis of sacroiliitis in young adults: study of 200 cases].

Diagnosis of sacroiliitis may be difficult to establish in patients under 25 years of age since growth is not yet completed and joint damage is often still minor. A prospective study of 200 subjects with a median age of 22 years was carried out to compare the value of CT scan and conventional radiology. The study population included 32 healthy subjects and 168 consecutive patients with presumptive spondylarthropathy including 36 with bilateral sacroiliitis and 8 with unilateral sacroiliitis. Conventional roentgenograms and CT scans were performed in every patient. Blind reading of roentgenograms and CT scans was carried out by two pairs of observers with differing experience. CT scan provided no additional information when reading was done by experienced observers: rates of mistaken and doubtful results were similar with both investigations (10%); specificity of both tests was comparable (90%) but sensitivity was significantly greater for CT scan (91.2%) than for conventional roentgenograms (71.6%), reflecting improved detection of roentgenographically occult sacroiliitis. Less experienced observers obtained better results with CT scans, illustrating the ease of interpretation of CT scan images. Analysis of false-positive CT scans revealed that normal variations and, above all, features due to as yet uncompleted growth were the main sources of mistakes. These mistakes cancelled the advantage of increased sensitivity of CT scan studies and explained why CT scan failed to improve diagnosis.

Adult↗
PubMed1992

A normal data base of posteroanterior roentgenographic measurements of the wrist.

In 120 adults, we measured the dominant wrist on posteroanterior roentgenograms in order to determine the normal dimensions and variations according to age and sex. Men and women were equally represented as were two age-groups (twenty-five to forty years and forty-one to sixty years). The roentgenograms were made, with standard exposure and development techniques, with the wrist and forearm in a neutral position and the x-ray tube aligned vertical to the radial styloid. The roentgenogram that was made with the wrist in the mid-coronal plane was digitized and was used to measure distances between specified landmarks. The mean ulnar variance was -0.9 millimeter (normal range, -4.2 to 2.3 millimeters). The average carpal height ratio was 53 per cent (normal range, 46 to 61 per cent). The mean radial inclination was 24 degrees (range, 19 to 29 degrees). The carpal-radial and carpal-ulnar ratios were smaller in women. The width of the distal radio-ulnar joint was reduced in the older subjects. There was a significant positive relationship (p < 0.0001) between the maximum force reached and the length of the third metacarpal. We believe that information concerning the normal roentgenographic measurements and relationship between the bones of the wrist can be used (1) to follow the progression of carpal instabilities, osteonecrosis, osteoarthrosis, or rheumatoid arthritis; (2) in clinical research; and (3) in the design of wrist implants.

Aged↗
PubMed1955

DUAL READING as a routine procedure in mass radiography.

Independent dual reading of survey films of the chest has been used as a routine method in the nation-wide Danish antituberculosis mass campaign. An attempt to evaluate the usefulness of this procedure is made in the present paper, which gives the results of dual reading of 431,550 technically adequate 35-mm chest films taken on adults in 12 Danish counties.The films were first read locally by the chief physician of the county and then subjected to an independent reading by a second (central) reader. All persons whose films were designated as suspicious (i.e., representing photofluorographic indication of pulmonary disease) by at least one of the two readers were referred to the county chest clinics for a large roentgenogram. Altogether 10,391 persons-or 2.4% of the total examined-were referred because of a suspicious chest film. The local and the central readers on an average agreed on only one-third of the referrals.Of the persons subjected to roentgenographic follow-up, 291 were found to have active pulmonary tuberculosis requiring treatment: 243 of these cases had been detected by the local readers, the central readers adding 48, or 20%. A further 2,804 persons presented evidence of clinically significant pulmonary disease other than active tuberculosis requiring treatment or observation: 1,924 of these referrals had been made by the local readers, the central readers adding 880, or 45%. In the remaining 6,907 persons, the large roentgenograms revealed either nothing abnormal or, in a small number of cases, only signs of healed pulmonary disease.Thus, of the 10,002 photofluorograms read as suspicious and checked by large roentgenograms, 6,907 must be classed as "false positives" and 3,095 as "true positives". While the local reading alone resulted in 2.1 false positives to each true positive, dual reading produced 2.2 false positives to each true positive-only a slight increase in the relative extent of over-reading.The reading of the photofluorographic material of the mass campaign was performed by 12 experienced chief tuberculosis physicians. All without exception overlooked clinically significant pulmonary changes in a considerable number of cases, but the individual variations were great. An independent second reading of the photofluorograms thus considerably increased the value, at relatively small expense, of the mass X-ray survey as a case-finding procedure.

Adult↗