Abstract
BackgroundCurrently, the detection of retained wood is a frequent but challenging task in emergency care. The purpose of this study is to demonstrate improved foreign-body detection with the novel approach of preclinical X-ray dark-field radiography.MethodsAt a preclinical dark-field x-ray radiography, setup resolution and sensitivity for simultaneous detection of wooden and metallic particles have been evaluated in a phantom study. A clinical setting has been simulated with a formalin fixated human hand where different typical foreign-body materials have been inserted. Signal-to-noise ratios (SNR) have been determined for all test objects.ResultsOn the phantom, the SNR value for wood in the dark-field channel was strongly improved by a factor 6 compared to conventional radiography and even compared to the SNR of an aluminium structure of the same size in conventional radiography. Splinters of wood < 300 μm in diameter were clearly detected on the dark-field radiography. Dark-field radiography of the formalin-fixated human hand showed a clear signal for wooden particles that could not be identified on conventional radiography.Conclusionsx-ray dark-field radiography enables the simultaneous detection of wooden and metallic particles in the extremities. It has the potential to improve and simplify the current state-of-the-art foreign-body detection.
Highlights
The detection of retained wood is a frequent but challenging task in emergency care
While x-ray radiography is highly sensitive for the detection of materials with high atomic numbers like metals, weakly absorbing foreign bodies are reportedly elusive in plain radiography
We found that the dark-field signal for wooden particles is related to an even higher signal level than the corresponding signal of aluminium on conventional radiography
Summary
The detection of retained wood is a frequent but challenging task in emergency care. Open wound care is one of the most frequent tasks in emergency care, while being closely related to the possibility of retained foreign bodies [1, 2]. For a patient with characteristic signs of a retained foreign body, physical examination is followed by a routine radiography [3]. Wood, the most frequent type of foreign body in the extremities, is likely to be missed in 85–95% of patients at the initial radiographic examination because of its low attenuation property [1, 3, 4, 6,7,8,9]. While x-ray radiography is highly sensitive for the detection of materials with high atomic numbers like metals, weakly absorbing foreign bodies are reportedly elusive in plain radiography. Even computed tomography (CT) does often not allow to distinguish wood from other hypodense materials like fat or air [6, 7, 9, 10]
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