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PubMed1979

[Diagnostic problems in chest injuries (angiography) (author's transl)].

Roentgenography is the simplest and most reliable means to arrive at the diagnosis of chest injury. General roentgenograms are difficult to interpret as they tend to be technically imperfect. Fractures, emphysema, pneumothorax, accumulation of fluid can usually be ascertained directly; but the traumatic origin of changes in the pulmonary parenchyma or of an enlarged heart shadow cannot be reliably deduced from the X-ray appearance. It may provide some differential-diagnostic information but the correct interpretation of the findings depends on further observation. In 6-7% of severe chest trauma with vascular injuries and rupture of the diaphragm angiography is indicated. The evidence to be obtained from chest radiography should not be overestimated: fractures of ribs are sometimes overlocked, even by the expert; parenchymatous lesions may manifest themselves as shadows but their nature remains obscure until they have been related to the clinical and subsequent radiological findings. The same applies to rupture of the diaphragm, bronchi or vessels, if only the immediate posttraumatic roentgenographs are examined. A tent-shaped heart shadow is considered characteristic of the presence of fluid in the pericardium; this is valid only for chronic hydropericardium, but not for the potentially fatal cardiac tamponade; if the pericardium has lost its elasticity a haemorrhage of not more than 150 ml may prove fatal. Nor does the roentgenogram provide information about pulmonary function. Especially in cases of pulmonary shock minor changes in the chest roentgenogram may give a false sense of security when, in fact, blood gas analyses show that a life-endangering situation has developed. The radiologist who is aware of the limititations of the method will derive maximum diagnostic benefit from a chest angiography. No other method is capable of supplying information of such great importance in such a short time.

Angiography↗
PubMed1979

A simple biplanar method of measuring femoral anteversion and neck-shaft angle.

A simple biplanar roentgenographic technique for measurement of femoral anteversion and neck-shaft angle is described in which no special equipment is required. An anteroposterior roentgenogram of the pelvis and the femoral neck is made with the hip in neutral rotation. The true lateral roentgenogram is made with the patient's limb in a lateral position with the hip and knee flexed and with the entire lateral aspect of the leg in contact with the top of the table. Projected cervicofemoral angulations are measured on the roentgenograms. The method is described to determine the true angles by dynamically illustrating the projected angles. Graphs have been prepared with which one can readily determine the anteversion and neck-shaft angles once the projected cervicofemoral angulations have been measured.

Femur↗
PubMed1984

A comparison of ambulatory test ordering for hypertensive patients in the United States and England.

We compared British and American patterns of ambulatory testing for chronic uncomplicated hypertensive patients by examining test use for 351 American patients cared for by 30 community-based internists in Massachusetts and 511 British patients cared for by 18 general practitioners in Greater London. For each of 13 tests examined, utilization was equal or higher for American patients. Significantly more ECGs, chest roentgenograms, plain roentgenograms (other than chest roentgenograms), blood cell counts, urinalyses, cervical cytological tests, barium enema examinations, and intravenous pyelograms were ordered. Differences ranged from four to 40 times higher in the United States. This investigation documents a marked difference in test use. Further study is needed to determine whether the conservative use of diagnostic services adversely affects patient outcomes or represents a more cost-effective form of care.

Clinical Laboratory Techniques↗
PubMed1984

[Morphological changes of the cervical spinal canal and cord due to aging].

UNLABELLED: Cervical spondylotic myelopathy is a condition in which degenerative changes of the cervical vertebral bodies and the intervertebral discs cause disturbances to the spinal cord either by direct mechanical compression or by disturbing the blood supply. There have been a number of studies on roentgenological measurements of the anteroposterior (AP) diameter of the cervical spinal canal relating to the disorder. However, there are only a few reports concerning the shape and the size of the spinal canal and the spinal cord. Murone reported that the cervical spinal canal of Japanese was significantly smaller than those of Europeans on roentgenograms. However, whether the size of the spinal cord of Japanese is proportionally smaller or not remains to be studied. The aim of the present study is to perform various measurements of the human cervical spine specimens to find any influence of the age on them and to see relative correlation of the spinal cord size to the corresponding spinal canal size. METHODS: Seventy-seven human cervical spinal columns taken én bloc from C3 to C7 at post-mortem examination were used for the study. After taking AP and lateral roentgenograms, the specimen was horizontally transsected at the middle of each vertebral body and at the level of each intervertebral disc. The reason why the middle of the vertebral body was selected is to exclude modifications by osteophyte formation at the upper and the lower ends of the body and to see possible genuine appearance and change of the spinal canal. The measured items were AP diameter of the vertebral body (A), AP diameter of the spinal canal (B), area of the spinal canal (C), AP diameter of the spinal cord (beta) and area of the spinal cord (gamma). In five untreated specimens, CT-scan was performed prior to the horizontal section, and the CT-scan findings were compared to those by direct measurements. Lateral cervical roentgenograms of 249 patients of various ages were used as a comparison. RESULTS: The AP diameter of the vertebral body (A) and the AP diameter of the spinal canal (B) showed some correlation with the age. The former became larger whereas the latter became smaller with the age. The area of the spinal canal (C) did not show correlation with the age. The AP diameter of the spinal cord (beta) showed correlation with the age, whereas the area of the spinal cord (gamma) failed to show the correlation.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1980

[Preoperative radiodiagnosis in dental-surgical interventions].

The goal of this study was to determine whether complications during the intervention can be forseen with an exact diagnosis. We therefore evaluated preoperative roentgenograms and analyzed the course of the operative intervention. Numerous additional pathologic findings, presented in diagrams, were identified on the orthopantomogram. Bent roots of third molars projecting into mandibular canal, for example, present certain problems. Intraoperative problems can be recognized on preoperative roentgenograms of the operative field without their being completely excluded; the preoperative roentgenogram therefore is necessary to limit complications.

Humans↗
PubMed1978

[Roentgen diagnosis of injuries of the ankle joint (author's transl)].

Lesions of the ankle joint affect the bone and/or ligaments. It will often be necessary to conduct additional radiological examinations besides the standard x-ray films. These additional examinations should include: 1. roentgenograms taken at an oblique angle; 2. x-ray films taken in forced extreme joint position in two planes; 3. roentgenograms comparing right and left; 4. arthrography. The article discusses the value and significance of the additional roentgenograms, with particular reference to the importance of the films of the forced extreme joint position.

Ankle Injuries↗
PubMed1981

[Intraosseous osteolytic lesions. Diagnostic, differential diagnosis and therapy (author's transl)].

Any pathological damage occurring in a bone will produce either an osteolytic or osteosclerotic lesion which can be seen in the macroscopic specimen as well as in the roentgenogram. Various bone lesions may lead to local destructions of the bone. An osteoma or osteoplastic osteosarcoma produces an osteosclerotic lesion showing a dense mass in the roentgenogram; a chondroblastoma or an osteoclastoma, on the other had, induces an osteolytic focal lesion. This paper presents examples of different osteolytic lesions of the humerus. An osteolytic lesion seen in the roentgenogram may be either produced by an underlying non-ossifying fibroma of the bone, by fibrous dysplasia, osteomyelitis or Ewing's sarcoma. Differential diagnostic considerations based on the radiological picture include eosinophilic bone granuloma, juvenile or aneurysmal bone cyst, multiple myeloma or bone metastases. Serious differential diagnostic problems may be involved in case of osteolytic lesions occurring in the humerus. Cases of this type involving complications have been reported and include the presence of an teleangiectatic osteosarcoma as well as that of a hemangiosarcoma of the bone.

Bone Cysts↗
PubMed1982

Long-term radiographic follow-up of total hip replacements.

This report relates the long-term clinical result with the serial radiologic findings of 350 consecutive total hip replacements done by the author. Thirteen femoral components and one acetabular component have been revised, and 12 of the 14 components had shown radiologic changes in the surrounding cement prior to the need for revision. Available roentgenograms at 6 weeks, 1 year, 5 years, and 8 to 10 years after surgery made radiologic assessment possible in 129 hips. Heterotopic bone formation, calcar resorption and distal cortical hypertrophy all appeared to be primarily radiologic findings with little effect on clinical results. A variety of changes seen in the cement or bone-cement interface were noted on the femoral component side of 13.6% of the hips. None of these patients had any symptoms or functional limitations. These radiologic femoral cement mantle changes showed a high correlation with apparently inadequate initial cementing techniques and were usually already seen on the 1- and 5-year postoperative roentgenogram. Only one acetabular cup was identified as radiologically loose and one as migrated. Radiolucent lines at the bone-cement interface on the acetabular side showed vascillating increases and decreases on the serial roentgenograms. Since the lucent lines on the acetabular component side improved as often as they increased in size, these lucencies did not seem to be of similar predictive value as those on the femoral side. Of the hips followed 8 to 10 years only 2 circumferential and 10 lucencies greater than 2 mm could be found. I could not correlate these with inadequate cup position or inadequate cement mantle on the initial radiograph. The 29 patients in this series who were under 50 years of age did not have a revision rate or radiologic change different from the group as a whole.

Adult↗
PubMed1980

High-yield referral criteria for posttraumatic skull roentgenography. Response of physicians and accuracy of criteria.

We evaluated a list of high-yield criteria (HYL) as a means of reducing posttraumatic skull roentgenograms and as a diagnostic test for skull fractures. Physicians requested roentgenograms for 76.9% of head trauma patients in a four-month control period, but for only 46.1% during a four-month experimental period, a relative decrease of 40%. When the experiment ended, roentgenogram use increased to 72% of head trauma patients. The HYL accurately classified 92.5% of the patients with and 84.5% of the patients without pathological conditions. The HYL displayed substantial differences in sensitivity and specificity from HYLs used previously. Clinicians disliked the HYL, believing it was inaccurate and a monitoring device. We conclude that criteria lists can effectively decrease requests for roentogenograms and should be carefully evaluated as diagnostic tests for accuracy and adverse outcomes.

Concurrent Review↗
PubMed1980

Roentgenologic determination of total lung capacity.

Geometric analysis of the chest roentgenogram allows calculation of estimated gas volume. If roentgenograms are made on individual patients or in epidemiologic studies in which relatively expensive nitrogen meters or body plethysmographs are not available, the thoracic roentgenogram provides an economical alternative. This study compares two roentgenographic methods of estimating total lung capacity in 154 subjects who also had total lung capacity estimated by the 7-minute nitrogen-washout technique or by total-body plethysmography. Results with the roentgenographic techniques were closely comparable with each other and with those of the gas-dilution and total-body plethysmograph methods in normal subjects. The planimetric method consistently estimated higher total lung capacity than the elliptic method in men and women with total lung capacity of 7.75 liters or less. In patients with severe obstructive lung disease, the roentgenographic methods were more closely comparable with body plethysmography, which is believed to be the most accurate, whereas the nitrogen-rinsing and similar gas-dilutional methods tended to underestimate the true volumes. The roentgenographic techniques also proved to be reliable in a small group of patients with varying degrees of pulmonary fibrosis.

Female↗
PubMed1995

[Primary pulmonary alveolar proteinosis--clinical observation of 68 patients in Japan].

The clinical features of 68 Japanese patients (53 men and 15 women; mean age 44 years) with primary pulmonary alveolar proteinosis were reviewed. Pulmonary alveolar proteinosis was diagnosed from histologic findings after open lung biopsy (n = 7) or transbronchial lung biopsy (n = 61). Major symptoms were a dry cough (24.2%) and dyspnea or shortness of breath on exertion (51.5%), but one third of the patients were asymptomatic. Crackles were audible in 30% of the patients, but clubbing (6%) and cyanosis (4%) were rare. Ten patients had been occupationally exposed to dust. Slightly less than half (46%) of the patients first presented with symptoms, and the remainder (54%) first presented with abnormal pulmonary infiltrates seen on chest roentgenograms taken during general health examinations. Many patients had abnormally high levels of LDH and CEA in serum (62% and 63%, respectively). Restrictive pulmonary dysfunction (%VC < 80%) was seen in 31% of the patients, an abnormally low DLco (%DLco < 70%) was seen in 62%,m and hypoxemia (PaO2 < 80 mmHg) was seen in 67%. Arterial blood gas tension was closely correlated with the severity of disease in these patients. Chest roentgenograms usually showed bilateral symmetric alveolar infiltrates, mainly distributed from hilar areas toward the pleura, but on CT scans many of the shadows were mixed with alveolar and interstitial infiltrates of various extent along the pulmonary arteries and bronchi. There was no apparent relation between chest roentgenographic findings and chest CT findings in these patients. Neither the extension nor other characteristics of shadows in the chest roentgenograms and chest CT scans were closely related to symptoms, laboratory data, or pulmonary function in these patients. Symptoms were alleviated and chest roentgenographic findings improved in 82% of the 51 patients who underwent therapeutic bronchoalveolar lavage, and in 94% of the 17 patients who did not undergo that procedure. In patients who underwent therapeutic bronchoalveolar lavage and also in those who recovered spontaneously, both diffusing capacity and blood gas values improved significantly. When compared to the patients who did not undergo therapeutic bronchoalveolar lavage, significantly more of those who did undergo that procedure has initial PaO2 values below 60 mmHg, and fewer of them had values greater than 80 mmHg. Thus, a PaO2 below 60 mmHg may be an indication for therapeutic bronchoalveolar lavage in patients with this disease. During the follow-up period (mean 5 years, range 2 months to 23 years), four patients had pneumothorax and none died of pulmonary alveolar proteinosis.

Adult↗
PubMed1994

[Femoral neck fractures: position of the implant, unrecognized articular penetration and its consequences].

INTRODUCTION: Only two dimensions of a three dimensional object are visible on plain roentgenograms. Therefore, on gross inspection of antero-posterior and lateral roentgenograms, a screw may project as being safely within the head of the femur even though penetration has occurred. This region may be referred to as a "blind zone". MATERIAL AND METHODS: Unrecognized screw penetration into the hip joint during internal fixation of femoral neck fractures was researched on intra operative roentgenograms of 30 patients. Unrecognized pin penetration through the posterior part of the neck was also analyzed on the same X Rays. RESULTS: Unrecognized screw penetration into the hip joint was observed in 20 per cent and penetration at the posterior part of the neck was observed in 10 per cent of cases. DISCUSSION: Several methods of determining screw position are described and discussed in this study.

Bone Nails↗
PubMed1994

[A case of chronic type farmer's lung which led to severe pulmonary fibrosis and spontaneous pneumothorax].

We present a case of chronic type farmer's lung which showed progressive pulmonary fibrosis and spontaneous pneumothorax 12 years after the first admission. A 56-year-old woman was diagnosed as having farmer's lung in 1981. After the first hospitalization, her chest roentgenogram showed regression with steroid therapy. After that, she sometimes worked at a dairy farm and required rehospitalization three times for recurrence. In April 1993, she was readmitted complaining of sudden chest pain and dyspnea after cough. Her chest roentgenogram on admission showed spontaneous pneumothorax. After treatment, her chest roentgenogram revealed severe pulmonary fibrosis and loss of lung volume.

Chronic Disease↗
PubMed1994

[Roentgen findings in bronchial tuberculosis].

To determine the value of chest roentgenographic findings in the diagnosis and therapy of endobronchial tuberculosis we analysed roentgenograms of 41 patients with endoscopically confirmed tuberculous involvement of the intrathoracic airways. 40 patients had infiltrates typical for pulmonary tuberculosis predominantly in the upper lobes. Signs of diminished air entry in form of collapse or consolidations were found in 52%. 10 patients had cavities and two had a destroyed lung. In only one patient the chest roentgenogram was completely normal demonstrating a case of isolated endobronchial tuberculosis. During antituberculosis drug therapy radiological signs improved in 38 of 41 patients, but in more than half of the cases stenoses persisted as verified by bronchoscopy. We conclude that endobronchial tuberculosis is usually accompanied by lung parenchyma involvement and that roentgenological findings are characterised by signs of pulmonary tuberculosis in most cases. A normal chest roentgenogram does not exclude endobronchial tuberculosis. Despite roentgenographic improvement during therapy tracheobronchial stenoses may persist. These findings justify to perform early fibreoptic bronchoscopy. Sputum conversion during the clinical course may indicate the most appropriate time for this examination.

Adolescent↗
PubMed1976

Essential knowledge about pitfalls in tomography.

Tomographic cut is not synonymous to a roentgenogram of an anatomic cut. Blurring is inherent in the tomogram, and the edges do not appear as sharp as in the conventional roentgenogram. Part of the contrast is lost in tomography. Therefore, when tissue contrast is low, or when we intend to see an entire structure in one cut, zoneography is preferred. On the other hand, when many details are crowded in a small area and/or when the tissue contrast is high, a thin section tomography is indicated. Proper knowledge of the level of area of interest (focal plane) and proper spacing of the cuts decrease radiation and expenses. The Law of Tangent, namely, "The edge of a structure should be momentarily parallel to the beam at the focal plane, in order to show on the film," is an essential part of every tomographic study. The Law of Tangent applies equally to spheres and other curved surfaces. The effective tomographic angle is the angle described by the tube during exposure. The thickness of the cut depends on the effective tomographic angle. Prior viewing of conventional roentgenogram and proper knowledge of the mechanism of parasitic and phantom images help us to avoid mistaking these images as real structures.

Axis, Cervical Vertebra↗
PubMed1994

[Spontaneous pneumothorax in Duchenne muscular dystrophy].

We retrospectively studied an incidence and clinical features of spontaneous pneumothorax (SPT) in Duchenne muscular Dystrophy (DMD) from chest roentgenograms and clinical records of our 50 inpatients, comparing those in severely mentally and physically disabled patients. Nine out of 50 (18%) DMD patients experienced SPT, and their chest roentgenograms showed no evidence of underlying pulmonary disease such as bulla, bleb, pneumonia. They were all asymptomatic. Clinical course was well, however, relapse occurred in 4 cases. The onset age was 20 or more in 7 patients (78%), and the incidence of SPT in patients aged 20 or more was 31%, which was 7.4 times higher than that of younger patients. Body weight at the onset of SPT was all below 30 kg, tended to be lower than that of SPT negative cases. Some patients experienced SPT after having lost their weight. SPT occurred much more frequently on the right side (right only, 7 cases; left only, 0; bilateral, 2 cases). Thoracic deformity and artificial ventilation were not major risk factors. We examined chest roentgenograms of 41 severely mentally and physically disabled inpatients, age, sex, and body weight matched and found no SPT. We conclude that SPT is frequent and asymptomatic in DMD and the major risk factors of SPT are age (above 20 years old) and body weight (below 30 kg), while thoracic deformity, and artificial ventilation are not essential.

Adolescent↗
PubMed1994

[A case of psittacosis with prolonged lymphocytosis in bronchoalveolar lavage fluid after resolution of pneumonia].

A 52-year-old man was admitted to another hospital with complaints of fever and dyspnea. Chest roentgenogram revealed bilateral widespread infiltrative opacities, and laboratory examinations showed severe hypoxia, hepatic injury and acute renal failure. In addition, hemosputum and eruption appeared, and he was transferred to our department because of the development of multi-organ failure. Moreover, about 2 weeks prior to admission, a budgerigar he had been breeding died. Although the treatment was supportive therapy alone, the abnormal shadow on chest roentgenogram and laboratory findings improved markedly. Thereafter, we made the diagnosis of psittacosis, because the serum titer of a complement fixation test against Chlamydia rose from 1:8 on admission to 1:512 after 2 weeks. On admission, PMN and lymphocyte populations increased in bronchoalveolar lavage fluid (BALF), and 2 weeks later lymphocytes alone increased markedly. Thereafter, we observed lymphocytosis in serial BALF findings for 12 weeks. These findings indicate that lymphocyte alveolitis persisted long after the pneumonia had resolved. Moreover, Ga scintigraphy also revealed accumulation in the filed of shadows which had been absorbed and disappeared on the chest roentgenogram. These results suggest that lymphocytes play a leading role in immune host defenses and that immunological reactivity is prolonged in psittacosis.

Bronchoalveolar Lavage Fluid↗
PubMed1993

[Radiographic waste coming from Flemish dental offices. A survey of a representative sample of 373 Flemish dentists].

Apart from amalgam, the materials used for dental radiography also endanger the environment. The debate on toxic chemicals in dentistry is focused on the way these radiographic materials (fixator, developer, the small lead plates and the old roentgenograms) are discharged into the environment. This study investigated the answers to the following research questions: What is the total volume of fixator, developer, small lead plates and old roentgenograms that is used in Flemish dentistry and what part ends up in the household waste? How do Flemish dentists manage (store and dispose of) these radiographic materials? A randomly selected group of 500 dentists working in the Flemish part of Belgium was invited to answer a mail questionnaire. A total of 373 dentists responded (response rate 74.6%), providing a representative sample. Of the 2.1 million roentgenograms made yearly in Flemish dentistry only 160,000 are dropped in the household garbage can. About 70% of the 2.2 million small lead plates used yearly in Flemish dentistry is discharged in the household garbage, to end on the rubbish-dump or in the combustion furnace where the lead vapours will poison the surrounding air. Although the storing and the ecological responsible discharging of the pollutants fixator and developer does not pose any problems, most of these products are discharged into the sewage system: about 80% of the 80,000 liter developer and 75% of the 70,000 liter fixator used each year in Flemish dentistry.

Attitude of Health Personnel↗