A Derived Exposure Chart for Computed Radiography in a Negroid Population

Background: Computed radiography has a wider exposure latitude when compared with film-screen imaging system. Consequently, the risk of dose creep is high. A conscientious effort is there-fore, needed by the radiographer to keep exposure as low as reasonably achievable. Objective: To derive a computed radiography exposure chart for a negroid population using AGFA photostimulable phosphor plates and a GE static X-ray machine. Materials and Method: A static X-ray machine, a digitizer, and photostimulable phosphor plates were used for the X-ray examination. Chest examinations were done at a Focus-Film-Distance (FFD) of 150 - 180 cm while all other examinations were conducted at 90 - 100 cm FFD. The range of exposure factors (kVp, mA and mAs) used by radiog-raphers in the centre was noted and the 90th percentile calculated. Over a three-month period, the patients were examined with the 90th percentile of tube potential (kVp) while keeping other factors constant. The kVp was gradually decreased and halted if radiologists and radiographers uncon-nected with the work expressed misgivings about the quality of the image. A similar procedure was adopted for the tube current (mA). The threshold adopted as low as reasonably achievable was the factor preceding the point of observation by other personnel. Metrics for central tendency from the statistical packages for social sciences, version 17.0 was used to analyze the data. Results: 335 subjects of both gender aged 0 - 92 years were examined by the researchers. Adult exposure factors used by the radiographers (and those derived by the researchers) had a range of 45 - 130 kVp (62 - 94 kVp), 63 - 320 mA (100 - 250 mA) and 4.0 - 25.0 mAs (5.0 - 20.0 mAs) respectively. Pediatric chest (and researchers-derived) factors were 50 - 75 kVp (52 - 65 kVp), 50 - 250 mA (100 - 220 mA) and 3.20 - 10.0 mAs (3.2 - 6.5 mAs) respectively. Conclusion: Upper threshold of adult (and paediatric) exposure factors in computed radiography with comparable equipment and accessories should not exceed 94 kVp (65 kVp), 250 mA (220 mA) and 20.0 mAs (6.5 mAs) respectively. The derived exposure chart is also adequate to address motion unsharpness in chest examinations.

Radiation Field Preference for Radiographic Anatomical Markers by Radiographers in a University Teaching Hospital in Nigeria

Objective: The work aims to determine the radiographers’ preference between primary and secondary radiation fields for imprinting anatomical markers on radiographs. Methodology: Processed radiographs from the darkroom with evidence of radiographic anatomical markings were selected randomly and reviewed using a viewing box, within a 4-week period. The radiation field in which markers were placed was noted for each radiograph. Faintly-appearing and partly coned- off markers were excluded. Simple statistical tools were used to derive central tendency. Result: 623 radiographs were assessed. 89.0% (n = 555) had markers in the primary radiation field while 11.0% (n = 68) were in the secondary radiation field. 98% (n = 611) of markers did not obstruct essential anatomy while 2% (n = 12) did, but the radiographs were neither repeated nor rejected because of the twin reason of reportability and the need to avoid additional radiation dose to patients. Conclusion: Radiographers in the centre preferred the primary radiation field for marker placement to avoid cone-off, cut-off and illegibility which leads to repeat. This, however, does not offer superior advantage to markers placed in secondary radiation field. It is recommended that marker placement preference should be guided by the need for legibility, aesthetics and avoidance of essential anatomy.

Fast and Low Cost X-Ray Stereoradiography Displayed on a 3D Monitor

Conventional x-ray stereoradiography based on film radiography is not practical due to its inconvenient and time-consuming procedures. In this research, an image viewing system consisted of a 30 cm × 30 cm gadolinium oxy-sulfide (GOS) fluorescent screen and a Cannon 500D digital camera were designed and constructed for real-time and near real-time x-ray imaging. The camera was connected to a laptop computer via USB port to allow remote camera setting and control as well as view image on the computer. The system was tested with x-rays generated from a Rigaku x-ray tube for its response at various camera settings and exposure times. The image brightness increased with increasing of the camera ISO setting and with the exposure time as expected. To test the system performance, two test specimens were radiographed including a video camera and a floppy disk drive as well as two simulated specimens. Each of the test specimens was also radiographed at two positions by moving the specimens approximately 6 cm from the first position. The two radiographs of each specimen were then combined to make an anaglyph image that could be viewed in 3D on a normal LCD or LED monitor by using appropriate color glasses. When the two radiographs were combined to make MPO (multiple object) file format, it could be viewed in 3D on a 3D monitor with or without 3D glasses depending on type of the monitor. The developed system could be conveniently employed for routine inspection of a specimen both in 2D and 3D within a minute.

Economic Evaluation of Conventional Radiography with Film and Computed Radiography: Applied at BMC

Conventional radiography with film (CRF) has been in use for diagnostic purposes for a long time now. It has proved to be a great assert for the radiographers in assessing various abnormalities. With recent advances in technology it is now possible to have digital solutions for radiography problems at a very cost effective, environment friendly and also with better image quality in certain applications when compared to CRF. Rather than using a CRF a computed radiography (CR) uses imaging plates to capture the image. The imaging plate contains photosensitive phosphors which contain the latent image. Later this plate is introduced into a reader which is then converted into a digital image. The major advantage and the cost effective element of this system is the ability to reuse the imaging plates unlike the photographic film where in only a single image can be captured and cannot be reused. The computed radiography drastically reduces the cost by eliminating the use of chemicals like film developers and fixers and also the need for a storage room. It also helps to reduce the costs that are involved in the disposal of wastes due to conventional radiography. This paper investigates whether it is cost effective to use computed radiography over film based system at Al-Batnan Medical Center (BMC), Tobruk, Libya by using Cost Benefit Analysis (CBA). Apart from the initial cost of the CR System, based on the data collected from the center, from the year 2008 to 2012 (until June 2012) a total of 581,566 images were produced with the total cost incurred using film based system being USD 4,652,528. If the same number of images were produced using a CR system the total cost incurred would have been USD 82,600. Taking into consideration the cost of a new CR system to be USD 120,000 the overall cost of producing these images is USD 202,600. It is observed that an amount of USD 4,449,928 could have been saved over the period of 5 years starting from 2008 to 2012 by using the CR system at BMC. Using Cost Benefit Analysis, the average value of the net difference between the costs and benefits for the conventional film based system is ?83.38 where as for the Computed System it is 22.06. Based on the principles of Cost Benefit Analysis it can be concluded that the system with a net positive difference is more cost beneficial than the other. With the help of the above two analysis it can be concluded that the use of computed radiography is definitely more cost effective for use at BMC, when compared to the conventional x-ray radiography.

Weld extraction from real-time radiograph based on bidirectional accumulator Hough Transform

An effective approach is presented to extract welds from real-time radiographs, Firstly an algorithm based on an adaptive bidirectional threshold was proposed to segment the gradient image into ternary image, and then the bidirectional accumulator Hough Transform was developed to extract weld edges from the ternary image. Different values of the coefficient proposed in the threshold algorithm were tested, and the proposed approach was applied to extract welds from real-time radiographic images of different types of welds with defects. Results show that the proposed method is adaptive and effective to extract welds from real-time radiographs of linear welds.

Skeletal dysplasias: A radiographic approach and review of common non-lethal skeletal dysplasias

Skeletal dysplasias are not uncommon entities and a radiologist is likely to encounter a suspected case of dysplasia in his practice. The correct and early diagnosis of dysplasia is important for management of complications and for future genetic counselling. While there is an exhaustive classification system on dysplasias, it is important to be familiar with the radiological features of common dysplasias. In this article, we enumerate a radiographic approach to skeletal dysplasias, describe the essential as well as differentiating features of common non-lethal skeletal dysplasias and conclude by presenting working algorithms to either definitively diagnose a particular dysplasia or suggest the most likely differential diagnoses to the referring clinician and thus direct further workup of the patient.

Lung cancer screening-don't forget the chest radiograph

Lung cancer is a major health burden and early detection only bears the possibility of curative treatment. Screening with computed tomography(CT) recently demonstrated a mortality reduction in selected patients and has been incorporated in clinical guidelines. Problems of screening with CT are the excessive number of false positive findings, costs, radiation burden and from a global point of view shortage of CT capacity. In contrast, chest radiography could be an ideal screening tool in the early detection of lung cancer. It is widely available, easy to perform, cheap, the radiation burden is negligible and there is only a low rate of false positive findings. Large randomized controlled trials could not show a mortality reduction, but different large population-based cohort studies have shown a lung cancer mortality reduction. It has been argued that community-based cohort studies are more closely reflecting the "real world" of everyday medicine. Radiologists should be aware of the found mortality reduction and realize that early detection of lung cancer is possible when reading their daily chest radiographs. Offering a chest radiograph in selected scenarios for the early detection of lung cancer is therefore still justified.

5-year audit of the range and volume of diagnostic radiographic services at the University of Nairobi Dental Hospital

Background: Dental and cranio-maxillofacial diagnostic imaging constitutes an invaluable tool in the accurate diagnosis and management of a diverse range of conditions and diseases that afflict the oral and cranio-maxillofacial region. In order to improve on any existing facility, periodic audit evaluation is paramount. In this way proper and relevant service delivery can be achieved. Objective: To evaluate the range and volume of dental and cranio-maxillofacial diagnostic radiographic services offered at the University of Nairobi Dental Hospital (UNDH) in Kenya over a 5-year period (2006-2010). Methods: Retro-spective survey involving manual examination of patient records at the Division of Dental and cra-nio-maxillofacial Radiology registry of the UNDH. Results: Over the study period, the range of diagnostic radiographic services offered comprised of both intra- and extra- oral examinations. The total volume of radiographs taken was 48,874 among which 41,980 (86%) were intraoral and 6894 (14%) extraoral views. Among the intraoral views, 74% were bitewing, 25% periapical and only 1% were occlusal diagnostic views. The majority (95%) of the extraoral projections consisted of panoramic views and only 5% constituted other techniques. The volume of radiographs was high from January to September while November and December had the lowest number of examination requests. Conclusion: Intraoral radiography was the commonest examination with bitewings having been the majority while the panoramic tomography was the commonest extraoral examination performed.

A Method of Digitally Reconstructed Radiographs Based on Medical CT Images

A complete and detail method is described to get digitally reconstructed radiographs （DRRs）. Casting rays to traverse CT images, computing CT values of resample points by interpolation, then converting CT value to its attenuation coefficient by using simplified segment function. Finally, DRRs enhancement is made to get the better display of region of interest （ROI）, and a new way is adopted to adjust the customization coefficient. The experimental results show that the proposed method is effective in generating the satisfied DRRs.

Chest radiograph usefulness in the diagnosis of acute aortic dissection

Objective To assess the diagnostic value of chest radiographs in patients presenting to a busy inner-city Emergency Department with subsequently proven acute aortic dissection. Methods A retrospective review of initial chest radiographs and charts of patients with the confirmed diagnosis of acute aortic dissection was done for a period of 5 years from 1998 to 2003. A comparison was made between the initial readings of chest radiographs prior to confirmation of the aortic dissection, and a retrospective review of the same radiographs by two board-certified radiologists with special attention to the classic findings of acute aortic dissection identifiable on plain films. Results The charts of nine patients (four men, five women) with proven acute aortic dissection were reviewed. All nine patients were suspected of having acute aortic dissection based on presenting history and symptoms of chest pain (66% ), migratory pain (89% ), back pain (89% ), and the abruptness of onset of pain (89% ). Initial plain portable chest X-rays were obtained in the Emergency Department in all nine patients. Six of nine (67%) radiographs were read as normal, while three (33%) demonstrated a widened mediastinum (＞ 8.0cm), two (22%) showed an abnormal aortic contour, with one ( 11% ) displaying an apical cap. Confirmation of the diagnosis was obtained with either a spiral CT angiogram or transesophageal echocardiography (TEE). All nine plain radiographs were retrospectively reviewed by two board-certified radiologists aware of the diagnosis of acute dissection without a change in the readings. Conclusions Plain portable chest radiographs are of limited usefulness for the screening of acute aortic dissection. Further radiologic evaluation should be dictated by the clinical presentation and an awareness of the low sensitivity of portable chest X- rays.

Development and psychometric evaluation of the radiographers’ competence scale

Assessing the competence of registered radiographers’ clinical work is of great importance because of the recent change in nursing focus and rapid technological development. Self-assessment assists radiographers to validate and improve clinical practice by identifying their strengths as well as areas that may need to be developed. The aim of the study was to develop and psychometrically test a specially designed instrument, the Radiographers Competence Scale (RCS). A cross sectional survey was conducted comprising 406 randomly selected radiographers all over Sweden. The study consisted of two phases;the development of the instrument and evaluation of its psychometric properties. The first phase included three steps: 1) construction of the RCS;2) pilot testing of face and content validity;and 3) creation of a web-based 54-item questionnaire for testing the instrument. The second phase comprised psychometric evaluation of construct validity, internal consistency reliability and item reduction. The analysis reduced the initial 54 items of the RCS to 28 items. A logical two-factor solution was identified explaining 53.8% of the total variance. The first factor labelled “Nurse initiated care” explained 31.7% of the total variance. Factor 2 labelled “Technical and radiographic processes” explained 22.1% of the total variance. The scale had good internal consistency reliability, with a Cronbach’s alpha of 0.87. The RCS is a short, easy to administer scale for capturing radiographers’ competence levels and the frequency of using their competence. The scale was found to be valid and reliable. The self-assessment RCS can be used in management, patient safety and quality improvement to enhance the radiographic process.

Development and Application of an Instrument for Analysis of Bone Structure on Radiographs

An instrument used for quantitative assessment of trabecular structure of radius on radiograph including trabecular number and trabecular width was developed using a microdensitometer and a single-chip microcomputer. The device is characterized by its high sensitivity, good reproducibility, convenience and economy. The results obtained with the instrument were significantly correlated to actual bone mineral content, This device can be used for the diagnosis of osteoporosis, fluorosis, rickets and bone damages caused by cadmium.

Can immediate postoperative radiographs predict outcomes in pediatric clubfoot?

BACKGROUND The goal of treatment for pediatric idiopathic clubfoot is to enable the patient to comfortably walk on his or her soles without pain.However,currently accepted treatment protocols are not always successful.Based on the abnormal bone alignment reported in this disease,some studies have noted a correlation between radiographic characteristics and outcome,but this correlation remains debated.AIM To assess the correlation between immediately postoperative radiographic parameters and functional outcomes and to identify which best predicts functional outcome.METHODS To predict the outcome and prevent early failure of the Ponseti’s method,we used a simple radiographic method to predict outcome.Our study included newborns with idiopathic clubfoot treated with Ponseti’s protocol from November 2018 to August 2022.After Achilles tenotomy and a long leg cast were applied,the surgeon obtained a single lateral radiograph.Radiographic parameters included the tibiocalcaneal angle(TiCal),talocalcaneal angle(TaCal),talofirst metatarsal angle(Ta1st)and tibiotalar angle(TiTa).During the follow-up period,the Dimeglio score and functional score were examined 1 year after surgery.Additionally,recurring events were reported.The correlation between functional score and radiographic characteristics was analyzed using sample and multiple logistic regression,and the optimal predictor was also identified.RESULTS In total,54 feet received approximately 8 manipulations of casting and Achilles tenotomy at a mean age of 149 days.The average TiCal,TaCal,Ta1st,and TiTa angles were 75.24,28.96,7.61,and 107.31 degrees,respectively.After 12 mo of follow up,we found 66%excellent-to-good and 33.3%fair-to-poor functional outcomes.The Dimeglio score significantly worsened in the poor outcome group(P value<0.001).Tical and TaCal showed significant differences between each functional outcome(P value<0.05),and the TiCal strongly correlated with outcome,with a smaller angle indicating a better outcome,each 1 degree decrease improved the functional outcome by 10 percent.The diagnostic test revealed that a TiCal angle of 70 degrees predicts an inferior functional outcome.CONCLUSION The TiCal,derived from lateral radiographs immediately after Achilles tenotomy,can predict functional outcome at 1 year postoperatively,justifying its use for screening patients who need very close follow-up.

Radiography of Clavicle Fractures— A Review of the Literature —Do Various Radiographic Views of Clavicle Fractures Affect the Management Plan?

Introduction: Fractures of the clavicle are common and make up 5% - 10% of all fractures. Treatment options in part depend on the location of the fracture along the bone and degree of displacement. These two parameters are best determined by good quality, standardized radiographs of the clavicle. We reviewed the literature to determine the optimal radiographs of clavicle fractures and their influence on the treatment plan. Methods: A comprehensive search of Medline? database was undertaken with the following search terms and MeSH headings: clavicle, fractures, bone, radiography, and X-ray. We included articles in English published from 1950 to present. We ruled out fractures in children, fracture dislocations, open fractures, those with neurological and vascular injuries and fractures involving the acromioclavicular or sternoclavicular joints. Findings: Of the 821 citations obtained, only four studies proved eligible. In the most pertinent, four orthopaedic surgeons were shown standard views (antero-posterior and 20&#176;cephalic tilt) of 50 clavicle fractures and then additional two views (45&#176;cephalic and caudal tilt), and found that alternative views influenced their decision making, with more surgeons opting for surgical fixation. In a different study, it was shown that orthogonal views of the clavicle increased surgeons’ understanding and improved their treatment of these fractures. The third paper was a case series on clavicle fractures that were missed on the initial antero-posterior radiograph, and the fourth paper postulated that postero-anterior views of the thorax were most accurate in determining length of the clavicle. Conclusion: Studies showing an optimal view for assessment of clavicle fractures with a decision to then progressing to operative fixation are few, but the evidence points towards surgical fixation when alternative views of mid-shaft clavicle fractures are present.

Clinical Applications of Successive Spot Radiographs in Esophagography for Diagnosing the Early Esophageal Cancer

Objective:To introduce primary experience of clinical applications of successive spot radiographs in esophagography for the diagnosis of early esophageal cancer(EEC). Methods: Six patients with EEC were examined and diagnosed by a digital X-ray machine.According to the routine double contrast study of esophagus,the patient gulped a barium suspension in the upright position when the successive films were taken by 2 frames per second lasting for about 10 seconds.Various phases were obtained including barium-filled views,mucosal relief views and double contrast views. Results: Functional changes and abnormal mucosal folds of esophagus were present on successive spot radiographs of esophagography in patients with EEC and those patients with EEC were confirmed by endoscopic and pathologic findings.Four patients had mild loss of distensibility,2 patients had spasmodic contraction and 1 patient had barium retention.Thickened or interrupted folds were found in all cases.Little niches were detected in 5 of 6 patients. Conclusion: Evidence presented in barium studies of esophagus is more comprehensive and intact for the diagnosis of EEC when successive spot radiographs are employed.Functional changes of esophagus are more evident with this approach.

A Retrospective Study of Radiographic Anatomy of Wrist in Chinese Population

In wrist pathology, there is a need to establish the normal range of radiographic measurement parameters. Previous study showed that the contralateral wrist might not be valid as a reference for all parameters. There is a lack of literature describing the normal range of wrist radiographic parameters in literature. As a result, a retrospective study was carried out. Patients who underwent standard wrist x-rays during the period February 2012 to February 2013 (one single year) were retrospectively reviewed. 71 patients were included. Scapholunate angle was 54.7° (±6.5°). Scapholunate interval was 2.0 mm (±0.4 mm). Ulnar variance was +1.0 mm (±1.8 mm). Carpal height was 31.8 mm (±3.0 mm). Radial inclination was 25.1° (±2.1°). All 71 patients had 1 sesamoid bone at first metacarpal. 16.9% (12 out of 71) patients had positive cortical ring signs. All these parameters are valuable clinically, especially in monitoring of the wrist disease progression, in the design of wrist implants and for future clinical research.

Natural course of ovarian torsion after untwisting: A case report with radiographic imaging

Background: Radiographic studies largely contribute to prompt diagnosis of ovarian torsion, though post-operative changes are not described and might contribute to unnecessary intervention. Case: We report a case of ovarian torsion diagnosed based on clinical presentation and radiographic findings. The detorsion was successfully performed through laparosopic access. Subsequently patient presented for elective ultrasonography and MRI which diagnosed multicystic ovarian mass, attributed to hematoma which resolved spontaneously with no intervention in 3 weeks. Conclusion: Ovarian changes after detorsion consistent with development of hematoma may be benign and resolve spontaneously.

Correlation of stress radiographs to injuries associated with lateral ankle instability

BACKGROUND Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability.AIM To determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability.METHODS A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed.These manual radiographic stress views were then correlated with magnetic resonance imaging and operative findings.RESULTS A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology(P=0.008 for tendonitis and P=0.020 for peroneal tendon tears).A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability(P=0.043).CONCLUSION Although valuable in the clinical evaluation of ankle instability,stress radiographs are not an independent predictor of conditions associated with ankle in-stability.

Investigation of coronoid process hyperplasia using Levandoski analysis on panoramic radiographs

BACKGROUND The diagnosis of coronoid process hyperplasia(CPH)is usually based on symptoms and radiological imaging.Because of its similar symptoms,it can be confused with temporomandibular joint diseases.Therefore,an objective and reproducible way of diagnosis should be determined.AIM To investigate CPH using Levandoski analysis on panoramic radiographs to determine its prevalence.METHODS A total of 300 panoramic radiograph images(600 coronoid processes)were examined.Having measured the Condyle-Gonion(Cd-Go)and Coronoid-Gonion(Cor-Go)distances,the Cor-Go:Cd-Go ratio was calculated for the left and right sides of each image.RESULTS There was a statistically significant difference in Cd-Go and Cor-Go distances between male and female participants(P<0.001).There was no statistically significant relationship between Cor-Go:Cd-Go ratios and gender(P>0.05).CONCLUSION Cd-Go and Cor-Go distances were statistically significantly increased in males on both the left and right sides.The ratio of Cor-Go:Cd-Go was preserved in both genders.The prevalence of CPH was found to be 0.3%.