ROC comparison of visualization of hand fractures using digital and conventional techniques

PURPOSE: To compare the accuracy of digital luminescence radiography (DLR) and conventional film-screen radiography (FSR) in diagnosing fractures. MATERIAL AND METHOD: Both conventional and digital radiographs were acquired from a consecutive series of 57 patients with suspected wrist or hand fractures. The digital images were obtained with a 30% dose reduction. A ROC-analysis (receiver-operating characteristics) was performed. RESULTS: The area under the curve was 0.89 for conventional FSR, 0.93 for DLR, "gray scale" and 0.94 for DLR, "edge enhanced". CONCLUSIONS: Although its spatial resolution is lower, DLR provided better results than conventional FSR, when contrast processing algorithms were optimised for the specific clinical question. The edge-enhanced version was superior to the non-edge enhanced version. The reason for this seems to be the higher contrast resolution of DLR compared to FSR.     

Primary diagnosis of osseous carpal area injuries--a comparison of conventional examination methods with digital luminescence radiography

Despite recent progress in improving diagnostic methods carpal bone lesions are still a major problem of primary diagnosis. Diagnostic imaging with digital luminescence radiography (DLR) allows the reliable presentation of traumatologically relevant carpal structures. In this study on 39 patients with suspected carpal bone injuries individually worked over DLR images were superior to "standard" DLR and conventional X-ray film/screen images. Though "standard" DLR images were inferior to film images edge-enhanced DLR images showed definite advantages in the demonstration of soft tissues. Fractures undetectable in conventional X-rays could not be recognized by digital imaging. In our experience bone-scanning remains the most reliable method for definite exclusion of carpal bone fractures after standard and digital X-ray methods are exhausted.     

Simultaneous multilayer arthrotomography of the temporomandibular joint using photostimulable phosphor computed radiography

OBJECTIVE: To compare the image quality of photostimulable phosphor computed radiography (CR) with that of a conventional screen-film system for simultaneous multilayer arthrotomography of the temporomandibular joint (TMJ). METHODS: X-ray attenuation, resolution and granularity was compared. Simultaneous multilayer tomography of TMJ was performed using a skull phantom and diagnostic quality of bone structures estimated. The clinical outcome is demonstrated in two typical cases. RESULTS: X-ray attenuation was larger with CR. Granularity was more prominent in edge-enhanced CR images and was associated with inferior diagnostic quality. However, it was improved by using a higher tube voltage. Clinical CR without edge enhancement showed a similar resolution to the conventional system but this decreased with enhancement. In an enhanced arthrotomogram, the boundary between contrast medium, bone and soft tissue were clearly defined and a fibrous adhesion also easily seen. CONCLUSION: Photostimulable phosphor CR is an acceptable alternative for simultaneous multilayer arthrotomography of the TMJ.     

Megavoltage imaging with low Z targets: implementation and characterization of an investigational system

The poor quality of stereotactic radiotherapy portal images is a limiting factor in precise image registration. To alleviate this problem, a low atomic number (Z) target was implemented on our Siemens MXE linear accelerator. This investigational system was used to assess the performance of various target materials by filming an aluminum contrast object. Beryllium, carbon and conventional target materials were studied. The bremsstrahlung spectra of these materials were simulated using Monte Carlo techniques. These spectra were used to calculate the dependence of narrow beam contrast on phantom thickness for verification of the data measured from film. A Monte Carlo simulation of the beryllium spectrum in a wide beam geometry was used to evaluate the effect of phantom-to-film distance on contrast. Although the same degree of contrast improvement with distance was not realized in practice, the improvement in image quality rivaled that achieved using a scatter reduction grid. A comparison of conventional localization images of the head and neck of an anthropomorphic phantom with images produced with a beryllium or carbon target and a mammography film and screen system supports earlier suggestions that the technique is clinically useful.     

Performance of various X-ray film/screen systems in demonstrating small simulated low-density lung nodules

A high-quality, conventional chest radiograph should be obtained in lung cancer screening programs to efficiently detect the faint, small nodular shadows due to early lung cancer in the lung fields, although, it is difficult to image the entire lung field within the linear part of the characteristic curve of the screen/film system owing to the wide variation in tissue density in the thorax, which ranges from the well aerated lung superimposed on the intercostal spaces to the lung area superimposed on the heart or diaphragm. In the detection of early cancer in the lung fields, it is important to consider the very low density (CT values of nearly -600 HU to -300 HU) commonly exhibited by early adenocarcinomas in the lung. The detectability of such nodules would be greatly influenced by the contrast and noise characteristics of the photographic system, the complexity of anatomical structures around the nodule, the characteristics of the observation system for x-ray films, the interpreter, and so on. The choice of x-ray film/screen system basically determines the efficacy of screening; specifically, the contrast characteristics of x-ray films together with noise level, which varies at different optical densities, affect the detectability of nodular shadows. The present study was carried out to determine the most suitable sensitometric characteristics and to assess the effects of the noise level of the x-ray film/screen system on the detectability of nodular shadows within the lung fields, particularly in low-density areas.     

Product update

OBJECTIVE: To compare fluoroscopic freeze-frame digital images with conventional 105-mm spot films during voiding cystourethrography (VCUG) with regard to diagnostic quality and radiation dose. MATERIALS AND METHODS: VCUG was performed on 57 consecutive children by a commercially available fluoroscopic digital system. Both freeze-frame digital images and conventional 105-mm spot films were obtained during 90 s of fluoroscopy. Skin radiation dose was assessed separately for spot films and for both fluoroscopy and spot films, employing thermoluminescent crystals on the anterior surface of the body. Patients were classified into three age groups: group A younger than 12 months, group B 1-5 years old and group C 5-12 years of age. RESULTS: Digital and conventional images provided diagnostically identical results in 108 out of 114 ureters examined (94.7%). Percentage reductions in skin radiation dose due to the fluoroscopic hard copies compared with the four 105-mm radiographs were 53.8%, 50.5% and 57.1% for groups A, B and C, respectively. CONCLUSION: Substitution of conventional 105-mm spot films during VCUG with digital fluoroscopic hard copies resulted in a substantial reduction in radiation dose. Digital images were as accurate as the conventional films in excluding vesicoureteric reflux (VUR). The two methods correlated well in diagnosing and grading VUR.     

On the dynamic range of different X-ray photon detectors in intra-oral radiography. A comparison of image quality in film, charge-coupled device and storage phosphor systems

OBJECTIVE: To compare film for intra-oral radiography with two charge-coupled device (CCD) and one storage phosphor system for digital imaging in respect of subjective image quality, detectability of small mass differences and appearance of burn-out effects and blooming phenomena at various exposure times. METHODS: Dried mandibles with teeth from different areas were radiographed at exposures covering a relative range from 1 to 100. Image quality was subjectively evaluated after image processing, when applicable, using a visual grading scale from 0 to 10. The number of visible holes in an aluminium block was used to measure the detectability of small mass differences. Burn-out effects and blooming were evaluated by measuring widths of roots and of aluminium and plastic cylinders. RESULTS: Radiographs with the storage phosphor system achieved image quality scores similar to those of film but over a larger exposure range, while CCD images were rated lower and over a smaller range. All holes in the aluminium block were only detected with the storage phosphor system. While the widths of roots were strongly affected by sensor saturation in CCD images and by burn-out in film images, smaller effects were seen with the storage phosphor system. Similar results were obtained with aluminium and plastic cylinders. CONCLUSIONS: Higher image quality was achieved over a much wider exposure range with the storage phosphor system than with either film or the CCD systems.     

Comparison of an asymmetric screen-film combination with a conventional screen-film combination for chest radiography in 51 patients

Comparison is made between a new asymmetric screen-film combination and a conventional screen-film combination for use in chest radiography. Seven anatomical features were assessed by three consultant radiologists in each of 51 film pairs. A preference was indicated if one system better demonstrated a particular feature. Alternatively, no preference was indicated if the feature was equally demonstrated by both systems or not demonstrated at all. Any pathology incidentally noted which remained unchanged between the two films was localized to lung, mediastinum or bone and marked in the same way. The asymmetric high contrast system scored higher than the conventional system for demonstration of anatomy in both mediastinum and lungs, but no difference emerged between the two systems in the demonstration of pathology. The asymmetric screen-film system showed improved mediastinal and, to a lesser degree, improved lung detail. Further assessment in necessary to define any associated improvement in diagnostic yield.     

A study of chest radiography with mobile X-ray units

A survey of radiographic technique and estimated entrance surface dose has been carried out for 364 chest radiographs performed with mobile X-ray equipment in the Intensive Therapy Unit (ITU) and 30 wards at Aberdeen Royal Infirmary. Data for these two types of location were compared, as were those for two film/screen systems used on the wards. Image quality assessments were made on sets of radiographs for two patients. Entrance skin doses for chest radiographs performed in the ITU were 50% greater than on the wards with the same film/screen system. The main technique difference was the use of shorter focus-to-skin distances (FSDs) in ITU. Doses with the Kodak Insight system were 20% higher than those using Du Pont Quanta III in similar locations. No correlation was found between image quality and entrance surface dose (ESD). Results from the survey were used to recommend exposure factors for shorter FSDs. A follow-up study revealed a 35-45% reduction in ESD for Kodak Insight and a 20% reduction for Quanta III.     

A laboratory evaluation of Ektaspeed Plus dental X-ray film

OBJECTIVES: The aim of this study was to make a laboratory evaluation of the image quality of a new dental X-ray film, Ektaspeed Plus, compared with Ektaspeed and Ultraspeed films. METHODS: Films of each emulsion type underwent a range of exposures at both 50 kVp and 70 kVp, and characteristic curves were constructed to give a comparison of fog, speed and contrast. Line pair and contrast detail test objects were used to assess the resolution of radiographs and the ability of the two film types to reproduce minor differences in subject contrast. The sensitivity of the emulsions to safelighting for a range of times was also tested. RESULTS: Ektaspeed Plus had the same speed, a slightly higher base plus fog density but a higher contrast (50 and 70 kVp) than Ektaspeed. The speed of Ektaspeed Plus was higher and the contrast similar to that of Ultraspeed film. Limiting resolutions of the three films were the same. There was a slightly better imaging of one contrast detail phantom with Ektaspeed Plus compared to Ektaspeed at 70 kVp only. All three emulsions were insensitive to recommended safelighting conditions. CONCLUSION: The improved image contrast of Ektaspeed Plus may be more acceptable to dentists than Ektaspeed and lead to a greater acceptance of E-speed film, contributing to dose reduction.     

Solution structure of a DNA complex with the fluorescent bis-intercalator TOTO modified on the benzothiazole ring

The aim of the present study was to evaluate and compare the reproducibility of cephalometric landmarks on (1) conventional films, and images acquired by storage phosphor digital radiography both on (2) hardcopy and (3) monitor-displayed versions. The material consisted of 19 cephalograms for each image modality. The phosphor plates were scanned in an image reader and the 10-bit normalized, raw data digital images were converted to 8-bit TIFF images for PC monitor-display. The digital hardcopies were produced in a laser printer. Six observers were asked to record 21 cephalometric landmarks on each conventional film, hardcopy, and monitor-displayed image. For the films and hardcopies, the landmark co-ordinates were recorded via a digitizing tablet. For the monitor-displayed images, the co-ordinates were recorded directly from the monitor using a dedicated Windows-based cephalometric program. Reproducibility was defined as an observer's deviation (in mm) from the mean between all observers. Differences between the image modalities and between the observers were tested by two-way analysis of variance for each landmark. There was a statistically significant difference between the reproducibility of film, hardcopy and monitor-displayed images in 11 of the 21 landmarks. There was no unequivocal trend that one modality was always the best. For a full cephalometric recording (the sum of all 21 landmarks), the monitor-displayed images (mean = 25.3 mm) had a lower precision than film (P < 0.005) and hard-copy (P < 0.02). There was no significant difference between film (mean = 21.8 mm) and hardcopy (mean = 22.8 mm). The lower reproducibility seen for the monitor-displayed images is most probably of little clinical significance.     

Contrast mapping and evaluation for electronic X-ray images on CRT display monitor

Simple chest X rays on film are the most common type of image in medical diagnosis. However, amongst the various types of medical X-ray images, they require the highest level of display quality due to the fact that the body structures they capture on film have varying degrees of permeability to X rays. Conventional high-definition digital display technology has not always been able to match the quality of such film images. This has been a major impediment against progress toward the complete digitization of simple chest X rays. The intent of this paper is to examine that, when applied to medical diagnosis of chest X rays, super-high-definition (SHD) images (digital images with resolution exceeding that of HDTV) are capable of producing a level of quality of diagnostic accuracy on a par with conventional film images. We will start out by seeking out the overall transmission characteristics of a system that uses digital radiography and a film digitizer to digitize images. We will then derive gray-scale transform characteristics based on the luminance linear method for approximating, as closely as possible on a CRT, film images on a light box that have wide dynamic range and high luminance. Finally, we will present the results of image evaluation experiments using high-definition CRT monitors. These results indicate that conventional film images and those on super-high-definition CRT monitors have nearly the same quality. They will also show that the contrast mapping selected by radiologists and theoretical luminance linear characteristics were almost the same except in low-luminance regions. We will also discuss radiologists' comments on CRT monitors after they participated in the evaluation experiment.     

Urodynamic correlates of resolution of reflux in meningomyelocele patients

PURPOSE: Resolution of reflux in meningomyelocele patients is a reflection of improved bladder storage. We correlated resolution of reflux with changes observed in sequential urodynamic studies. MATERIALS AND METHODS: The study included 27 children with meningomyelocele born between 1975 and 1985 who presented with or developed vesicoureteral reflux. Resolution of reflux was observed during the 10-year followup period as they were treated with a regimen of clean intermittent catheterization and pharmaco-therapy. Urodynamic studies were performed when vesicoureteral reflux was present and subsequent to its resolution. The urodynamic parameters compared in the 2 studies included bladder capacity, pressure specific bladder volume, bladder compliance and leak point pressure. RESULTS: Significant increases in bladder capacity, pressure specific bladder volume and bladder compliance were noted. Leak point pressure appeared to be decreased subsequent to resolution of reflux. CONCLUSIONS: Resolution of reflux in meningomyelocele patients correlates with changes in parameters of bladder storage observed on sequential urodynamic studies.     

Vesicoureteral reflux in children: incidence and severity in siblings

PURPOSE: We attempted to determine the incidence of vesicoureteral reflux in asymptomatic siblings of children with reflux at different ages and assess the incidence of renal damage in asymptomatic siblings with reflux. MATERIALS AND METHODS: We reviewed radionuclide cystograms of 482 consecutively referred siblings of children with vesicoureteral reflux, including 295 girls and 187 boys 2 weeks to 12.8 years old (mean age 2.8 years). Ultrasonograms and renal cortical scintigrams of children with reflux were evaluated. All siblings were considered asymptomatic by the referring physicians. RESULTS: The overall incidence of vesicoureteral reflux was 36.5%, and the incidence in girls and boys was 39.3 and 32.1%, respectively. Children 24 months old or younger had the highest incidence (45.7%) and the highest risk of bilateral reflux. From ages 25 to 72 months the incidence of reflux was 33.1% and in siblings older than 72 months it was 7%. Reflux of urine to the level of the renal pelvis was detected in 28.6% of all referred siblings. Renal damage was observed on sonography or scintigraphy in 4.7% of the siblings with reflux. CONCLUSIONS: The high incidence of vesicoureteral reflux through age 72 months indicates that it is important to screen siblings of children with reflux at an early age to prevent renal damage, which can occur in the absence of symptomatic urinary tract infection.     

An observer study for direct comparison of clinical efficacy of electronic to film portal images

PURPOSE: To directly compare clinical efficacy of electronic to film portal images. METHODS AND MATERIALS: An observer study was designed to compare clinical efficacy of electronic to film portal images acquired using a liquid matrix ion-chamber electronic portal imaging device and a conventional metal screen/film system. Both images were acquired simultaneously for each treatment port and the electronic portal images were printed on gray-level thermal paper. Four radiation oncologists served as observers and evaluated a total of 44 sets of images for four different treatment sites: lung, pelvis, brain, and head/neck. Each set of images included a simulation image, a double-exposure portal film, and video paper prints of electronic portal images. Eight to nine anatomical landmarks were selected from each treatment site. Each observer was asked to rate each landmark in terms of its clinical visibility and to rate the ease of making the pertinent verification decision in the corresponding electronic and film portal images with the aid of the simulation image. RESULTS: Ratings for the visibility of landmarks and for the verification decision of treatment ports were similar for electronic and film images for most landmarks. However, vertebral bodies and several landmarks in the pelvis such as the acetabulum and public symphysis were more visible in the portal film images than in the electronic portal images. CONCLUSION: The visibility of landmarks in electronic portal images is comparable to that in film portal images. Verification of treatment ports based only on electronic portal images acquired using an electronic portal imaging device is generally achievable.     

包晶钢连铸保护渣固渣膜生长及成分偏析试验

 保护渣渣膜的形态及性能对提高连铸坯质量及稳定连铸生产起着至关重要的作用。采用改进型水冷铜探头冷凝获取不同探头浸入时间下的包晶钢保护渣固渣膜,通过光学显微镜及SEM观察方法检测及评价保护渣渣膜的内部结构特性,并结合SEM-EDX检测了渣膜不同部位各主要成分的偏析情况,分析了渣膜凝固过程中凝固前沿元素的偏聚规律。研究结果表明,本渣系及试验条件下,保护渣渣膜主要晶体为枪晶石与三斜霞石;枪晶石凝固析晶过程中凝固前沿成分变化促进了三斜霞石等高熔点相在渣膜凝固前沿与枪晶石混合析出,使得固渣膜厚度迅速增加。     

Is image selection a useful strategy to decrease the transmission time in teleradiology? A study using 100 emergency cranial CTs

This study examines the suitability of working with a selection of images in a teleradiology consulting system in neurological or neurosurgical emergency situations. The teleradiology system was based on IBM-compatible personal computers, video digitization for data acquisition, and data transmission by Integrated System Digital Network. Forty normal and 60 abnormal emergency cranial computed tomograms were shown to a radiologist on call who presented all cases he regarded as pathologic to a neuroradiologic expert by teleradiology. To reduce transmission time, only a selection of images from the CT study was presented (up to four images per case). For each case the on-call radiologist's diagnosis (D(on-call)), the expert's diagnosis on the teleradiology screen (D(monitor)), and the expert's diagnosis on the original film (D(original)) was documented, together with an estimation of the agreement between those diagnoses. There was clinically relevant disagreement between the on-call radiologist's diagnosis and the neuroradiologist's diagnosis based on the image selection on the teleradiology monitor in 23% of cases. A clinically important discrepancy between the neuroradiologist's diagnosis based on the image selection and his diagnosis using the original films was found in 30% of cases. This was due to the presence of clinically relevant information on images not transferred by the on-call radiologist. Image quality of the transferred images was sufficient in all cases. Drastic selection of images from a complete CT study leads to a high rate of incorrect diagnoses and is not appropriate to reduce transmission time in teleradiology.     

Relative susceptibilities of XPA knockout mice and their heterozygous and wild-type littermates to UVB-induced skin cancer

Sensitometric techniques for performing processor quality control in laser imaging systems are analyzed in this study. The sensitivity of conventional x-ray films using simulated screen-light sensitometry is compared with helium-neon (HeNe) laser film exposed with a simulated red-light sensitometer, a standalone (reference) laser sensitometer, an experimental (unstable) laser sensitometer, and laser printers. Infrared (IR) laser film exposed with an IR laser diode and a simulated IR sensitometer are also evaluated. It is demonstrated that laser-generated step tablets provide an easy and reliable method of performing laser film processor quality control.     

Advanced multiple beam equalization radiography (AMBER) combined with computed radiography. Preliminary evaluation

The combined use of AMBER (Advanced Multiple Beam Equalization Radiography) and a digital storage phosphor (SP) radiography system was evaluated for chest radiography in a pilot study with 4 patients. Four image modes with different dose levels were compared: the SP in combination with an AMBER equalized exposure (SP/AMBER) and 3 nonequalized exposures with dose levels corresponding to the respective calculated AMBER lung dose (SP/lung field dose), the calculated AMBER mediastinal dose (SP/mediastinal dose) and the calculated AMBER average dose (SP/average dose). All image modes were matched for Hurter and Driffield characteristics and subjectively rated according to visibility of details. The improved signal-to-noise (S/N) ratio of SP/AMBER resulted in a better visualization of structures in the mediastinum and the basal lung where SP/lung field dose scored lowest. For the central lung no quality differences were seen between techniques. The compressed dynamic range of the SP/AMBER images was more easily displayed on the hard-copy film. The combination of AMBER with SP radiography promises to overcome the dynamic range limitations of digital displays while, at moderate doses, giving better S/N and image quality than standard SP technique.     

Technical note: physical evaluation of recent Kodak films for mammography

Four Kodak films for mammography were evaluated for image quality and dose. Processing times and storage effects have also been evaluated.