Conventional Film Radiography Research Articles

Computed chest radiography for total body irradiation: image quality and clinical feasibility

Objective. In myeloablative total body irradiation (TBI), lung shielding blocks are used to reduce the dose to the lungs and hence decrease the risk of radiation pneumonitis. Some centers are still using mega-Volt (MV) imaging with dedicated silver halide-based films during simulation and treatment for lung delineation and position verification. However, the availability of these films has recently become an issue. This study examines the clinical performance of a computed radiography (CR) solution in comparison to radiographic films and potential improvement of image quality by filtering and post-processing. Approach. We compared BaFBrI-based CR plates to radiographic films. First, images of an aluminum block were analyzed to assess filter impact on scatter reduction. Secondly, a dedicated image quality phantom was used to assess signal linearity, signal-to-noise ratio (SNR), contrast and spatial resolution. Ultimately, a clinical performance study involving two impartial observers was conducted on an anthropomorphic chest phantom, employing visual grading analysis (VGA). Various filter materials and positions as well as post-processing were examined, and the workflow between CR and film was compared. Main results. CR images exhibited high SNR and linearity but demonstrated lower spatial and contrast resolution when compared to film. However, filtering improved contrast resolution and SNR, while positioning filters inside the cassette additionally enhanced sharpness. Image processing improved VGA scores, while additional filtering also resulted in higher spine visibility scores. CR shortened TBI simulation by over 10 minutes for one patient, alongside a dose reduction by order of 0.1 Gy. Significance. This study highlights potential advantages of shifting from conventional radiographic film to CR for TBI. Overall, CR with the incorporation of processing and filtering proves to be suitable for TBI chest imaging. When compared to radiographic film, CR offers advantages such as reduced simulation time and dose delivery, re-usability of image plates and digital workflow integration.

Inter-Examiner Agreement of the National Upper Cervical Chiropractic Association Analysis of the Atlas Subluxation Complex in a 3-View Upper Cervical Radiographic Series

ObjectiveThe purpose of this study was to measure the inter-examiner agreement between radiograph markings of 2 National Upper Cervical Chiropractic Association board-certified chiropractors. MethodsTwo chiropractic examiners who had standardized training marked and analyzed 254 conventional orthogonal radiographic film sets. The level of agreement and potential biases in their measurements were assessed using intraclass correlation coefficients for absolute agreement and Bland-Altman plot analyses. ResultsThere was 96.1% agreement between the examiners in the measurements of the side of atlas laterality and 94.5% for atlas rotation. The intraclass correlation coefficient was 0.95 (95% CI, 0.93-0.96) for atlas laterality and 0.92 (95% CI, 0.89-0.94) for atlas rotation. The mean difference in the measurement between the 2 examiners was −0.11, P = .12 for atlas laterality and 0.05, P = .55 for atlas rotation. Neither atlas laterality nor atlas rotation measurements were significantly different from zero. Bland-Altman plots were not suggestive of any proportional biases in the 2 measurements. ConclusionResults of this study show almost perfect agreement between 2 trained chiropractic examiners, with no apparent proportional bias in the analysis of conventional orthogonal radiographic film sets.

Knowledge level on imaging exams protocols in pediatric dentistry: a cross-sectional study with questionnaire

This study aimed to evaluate the knowledge level of Dentistry students, who have already taken the Dental Radiology and Maternal Child 1 courses at the University of Caxias do Sul in May 2020, on the appropriate prescriptions and protocols of different imaging exams in their daily clinical practice. Materials and Methods: A questionnaire was developed using the Google Forms online platform and divided into different sessions: a) personal information; b) prescription of CBCT; c) students' specific knowledge regarding CBCT images; d) prescription of dental radiography techniques; e) imaging diagnostics; f) exposure dose; g) care with the radiation protection of both the professional and the patient during processing time for conventional radiographs. Fifty-six participants received the form by email. Results: Regarding CBCT, 66.6% of the respondents have already used it, and 91.6% believe that it is essential to have easy access to this technology. Whereas 37.5% declared thorough knowledge of the main terminologies, 66.67% stated that they rarely prescribe CBCT. Regarding radiation protection, 97.92% of the respondents said they wear a lead apron to ensure patients' protection; however, 23% of the aprons do not include a thyroid gland shield. As for the sensitivity of radiographic films, 50% of the respondents use radiographic film F. Conclusion:Thus, we found that a lack of specific knowledge on CBCT examinations and on conventional radiographic films exists among dental surgeo.

Analysis of photostimulable phosphor image plate artifacts and their prevalence.

BACKGROUND Digital radiography has recently been used in dentistry as a substitute for conventional film radiography worldwide. Digital imaging has many advantages and provides new possibilities for recording and interpreting radiographic data. This system uses different types of digital receptors.AIMTo detect the frequency, type, and reasons behind the appearance of intraoral image artifacts acquired by photostimulable phosphor plates (PSP).METHODSThis retrospective descriptive study was conducted in the oral and maxillofacial radiology unit of the dental clinics of the College of Dentistry, Princess Nourah University (PNU). All intraoral digital radiographs were acquired using (Gendex Expert DC., United States) an intraoral X-ray machine with 7 -mA, 65-kVP using a PSP system (Soredex DIGORA Optime imaging plate) and laser scanners (Soredex DIGORA Optime), which can house all sizes of reusable intraoral PSP sensor plates with image acquisition software (MIPACS Dental Enterprise viewer 3.2.2). A total of 50000 intraoral radiographs were retrieved from the clinical database from April 2018 to April 2020 to evaluate the reason, type, and solutions to these image artifacts.RESULTSOverall, 50000 intraoral digital radiographs were acquired in a two-year-period; that is, from April 2018 to April 2020. Of these, 3550 (7.1%) retakes were performed due to the presence of image artifacts. Periapical radiographs were the most common image type of intraoral retakes (80.8%). Imaging artifacts were divided into three categories: operator, plate and scanning errors. Out of 3550 retakes, 5%, 1.37%, and 0.73% were related to operator, plate, and scanning errors, respectively. The cone cut was the most common operator error (988 images), Bite marks were the most common plate error (276 images), and delayed scanning artifacts were the most common scanning errors (145 images). The calculated kappa value for interobserver reliability was 0.99, indicating almost perfect interobserver agreement. CONCLUSIONOur study discussed intraoral image artifacts that were characteristic of PSP, where the most common artifacts were bitemarks, image size reduction, scratches, and delayed scanning.

Application of computerised radiography in lieu of film radiography to streamline on-site pipe weld quality inspection process

Conventional film radiography has long been the dominant method of non-destructive testing in the Australian pipeline industry. Although proven, the process has disadvantages, including environmental issues with chemical processing and film disposal, significant archival space requirements, film deterioration, and difficulty in traceability and safe sharing with others. In contrast, computerised radiography (CR), using a phosphorus-laden reusable imaging plate and X-ray radiation to generate a latent digitally scannable image, is a clean, compact and efficient process. Although CR has been used on other applications, such as profile radiography for more than a decade, the process has not been considered advanced enough for weld testing until now. After a comprehensive qualification/validation process, CR was successfully used on 481 km of the 622-km-long Northern Gas Pipeline (NGP) Project by McConnell Dowell in the Northern Territory. Proven on approximately 26000 welds, this thinking has changed for good.

The radiological assessment of shoulder pathology

Radiological imaging plays a central and invaluable role in the assessment and management of patients with suspected shoulder pathology. Whilst conventional plain film radiography remains the first-line investigation of choice, limitations with its ability to evaluate the soft tissue structures means that it is usually supplemented with ultrasound and/or MRI. The following article reviews common and uncommonly encountered shoulder pathologies and their respective imaging findings, with a specific focus on their ultrasound and MRI appearances.

Cone Beam Computed Tomography (CBCT) in General Dental Practice.

Cone beam computed tomography (CBCT) can be a useful adjunct to conventional plain film radiography, but its use must be carefully justified as the radiation dose is generally higher. Factors affecting the dose include the field of view (FOV) size, the exposure factors, the angle of rotation and voxel size. Once justified, the exposure should be fully optimised to ensure the dose to the patient is kept as low as possible while ensuring there is no reduction in the diagnostic yield. The European Commission (EC) and the Faculty of General Dental Practice (FGDP)(UK) have published selection criteria on the use of CBCT in dentistry. This article provides an overview of CBCT and summarises the latest guidance on selection criteria relevant to the general dental practitioner.

Application of Different X-ray Techniques to Improve In-Service Carbon Fiber Reinforced Rope Inspection

Carbon fiber reinforced polymer ropes are gaining in significance in the fields of civil engineering and hoisting applications. Thus, methods of non-destructive testing (NDT) need to be developed and evaluated with respect to new challenges and types of defects. Particularly important is the development of in-service testing solutions which allow the integration in global online monitoring systems. Conventional methods like electrical resistivity or strain measurements using optical fibers are already in use. This study investigates the possibility of using various X-ray techniques to increase the reliability and significance of NDT and their applicability to in-service testing. Conventional film radiography is the most common technique; however, even after image enhancement of the digitized film, this technique lacks contrast sensitivity and dynamic range compared to digital detector array (DDA) radiography. The DDA radiography is a highly sensitive method; yet, the limitation is that it delivers 2D images of 3D objects. By the use of co-planar translational laminography the detectability of planar defects is superior to 2D methods due to multiple projection angles. Apart from this, it can be used on-site due to a rather simple setup and robust equipment. In this work two photon counting detectors (PCD) with different sensor materials (Si and CdTe) were used. The results show that the resolution and defect recognition is lower in case of DDA radiography and laminography using PCDs compared to high-resolution computed tomography. However, the DDA radiography and laminography are sensitive enough to both fiber breakage and delaminations and can be significantly advantageous in terms of measurement time and adaptability for on-site monitoring.

Visualization method for radiographic films through silver intensity mapping using X‐ray fluorescence

Radiographic films have a large range of applications. In many of these applications, the behavior of characteristic curves is very important for assessing the image quality and radiography setup. Radiographic film digitization and visualization are always performed by light transmission, and the characteristic curve is known as a behavior of optical density as a function of the radiation exposure. Because optical density is a function of metallic silver generated by chemical development in silver halides, when an image is visualized by light transmission, a silver amount map is indirectly seen. However, this measurement is limited by the optical instrument, and a very weak light signal cannot be distinguished from background light or background noise. In this way, highly exposed films can contain areas with different silver concentrations, but this cannot be seen because the optical density measurement is limited. One of the ways through which it is possible to overcome such limitation is to use a different method for ascertaining the quantity of silver remaining on the developed films, and one of the quantitative techniques that suit this purpose is X‐ray fluorescence (XRF). The purpose of this paper is applying μ‐XRF so as to obtain a point‐by‐point silver intensity map to detect objects with low optical contrast on conventional radiographic films. The results of this work have shown a higher linear range in measurement using XRF, and as consequence, small objects and details in low‐contrast or overexposed radiographic images could be visualized by the silver mapping technique, and the same results could not be achieved using light transmission methods. A first approach about spatial resolution and contrast was made showing strong and weak points of this way to scan radiographic films. Copyright © 2017 John Wiley & Sons, Ltd.

Identification of simulated periapical diseases using five different diagnostic imaging methods

ObjectivesTo assess and compare five diagnostic imaging methods used in the identification of periapical diseases, of different diameters, mechanically simulated. MethodsThe sample of the present study consisted of 12 dried human mandibles. Digital panoramic radiography, conventional and digital periapical radiography (charged couple device and photo-stimulable phosphor plate), and high-resolution cone beam computed tomography (CBCT) were previously performed to exclude regions presenting periapical lesions or similar conditions, which then formed the control and experimental groups. Then, periapical diseases were progressively produced with drills of different diameters, thus creating lesions of different sizes. The different image diagnosis methods were applied after each lesion produced. The data were assessed using the Kappa test, ROC curve graphs and Cochran's Q test. The significance level was set at 0.05. ResultsThe images obtained with conventional film and digital panoramic radiography showed the worse results (0.65 and 0.55, respectively), and statistically significant differences compared to the controls (p<0.05) for lesions artificially produced with #6 drill. With regard to high-resolution CBCT, the area values were found to be high for all lesion sizes. ConclusionConventional periapical radiography and digital panoramic radiography did not provide satisfactory images for the identification of incipient periapical diseases. The high-resolution CBCT showed high accuracy in the diagnosis of periapical diseases in both regions evaluated, and proved to be the most reliable method for the identification of initial periapical diseases (1.8mm).

The quality of radiographs accompanying endodontic referrals to a health authority clinic.

To assess the quality of radiographs accompanying endodontic referrals, from general dental practitioners, to a health authority clinic. A total of 200 conventional film and digital radiographs accompanying referrals were assessed and rated as 'excellent', 'diagnostically acceptable' or 'unacceptable' according to the National Radiographic Protection Board (NRPB) guidelines. Statistical analyses of the results included inter- and intra-observer agreement to achieve a kappa score and the chi-squared test. Out of the 200 radiographs assessed, 38 (19%) were conventional film and 162 (81%) were digital. Of the conventional film radiographs, 55% were rated 'excellent' and 37% were 'diagnostically acceptable', whilst 27% of digital radiographs were rated 'excellent' and 40% were 'diagnostically acceptable'. In the 'unacceptable' category, 33% were digital and 8% were conventional film radiographs (p <0.001). The quality of digital radiographs was significantly lower compared with conventional film radiographs. The percentage of 'unacceptable' digital radiographs was above the target according to the NRPB guidelines. Hence, there is a need for improvement in quality to avoid repeat radiographs and unnecessary ionising radiation exposure. Instead of hard, printed copies, digital radiographs accompanying referrals should, within the parameters of information governance, be supplied electronically so that they may be optimised, if necessary, for better diagnostic value.

The radiological diagnosis of infection

Abstract Musculoskeletal infections can involve bone, joints, muscles and soft tissues. The interpretation of imaging in musculoskeletal infections can be a diagnostic challenge and requires an integrated approach with clinical details and blood inflammatory markers. Imaging also plays a vital role in treatment planning and follow up. Conventional plain film radiography is still the cornerstone, which provides an overview of the bone and surrounding soft tissue pathology and should routinely be the first imaging procedure in patients with suspected musculoskeletal infection. The sensitivity of radiographs for the detecting of acute osteomyelitis is limited. Ultrasound can be used to assess soft tissue collections, joint effusions, and foreign body localization. It is invaluable in providing guidance for diagnostic joint aspiration, biopsy or therapeutic drainage of a soft tissue abscess/collection. CT scans are useful in providing bony detail and are particularly useful for evaluation of presence of sequestrum and in cases where MRI is contraindicated. MRI provides excellent anatomical details and evaluates both the soft tissues and bones and is the most sensitive and specific imaging modality for evaluating musculoskeletal infection. Radionuclide imaging can be helpful in cases of acute osteomyelitis and multifocal infection and has a high negative predictive value when normal.

In vivo comparison of Kodak E-speed film and direct digital imaging system for assessment of interproximal bone loss

Aims: To evaluate the diagnostic accuracy of direct digital radiography as compared to a conventional radiographic film for the assessment of interproximal bone loss with intrasurgical measurements as the gold standard. Materials and Methods: A total of 100 patients, with untreated moderate-to-advanced periodontal disease, were included in the study. The presurgical radiographs were made using a Kodak E-speed film and a Dexis digital sensor simultaneously, for sites with interproximal bone loss. At the time of surgery, the distance from the cementoenamel junction to the bone defect (CEJ-BD) was measured for 331 interproximal defects. The radiographs were randomized and then linear measurements were taken for the same sites in both conventional and digital radiographs. Stastistical Analysis: Comparison between the conventional, digital, and intrasurgical measurements was done statistically using the Student's t-test. The agreement and correlation among the methods was assessed using the weighted Kappa measure of agreement and Pearson's correlation, respectively. Results: The results showed that the conventional (5.15 ± 2.19 mm) and digital analyzing techniques (5.13 ± 2.19 mm) underestimated the interproximal bone loss, as compared to the intrasurgical measurements (6.07 ± 2.05 mm) (p < 0.001). The difference between conventional and digital radiographic methods was found to be statistically insignificant (p = 0.92). Conclusion: Under normal clinical use, the alveolar bone levels revealed on intraoral direct digital radiographs and Kodak E speed film were almost same. Therefore, the digital radiographic system can be routinely used in clinical practice as an alternative to conventional film.

In vitro Comparison of Conventional Film and Direct Digital Radiography in Proximal Caries Detection

Introduction: Various systems for intraoral digital radiography have been available as an alternative to film-based radiography. In consideration of several advantages of digital radiography such as less patient absorbed dose, manipulation of im- age quality and elimination of processing, it has been extensively used in different fields of denti- stry in recent years. The purpose of this study was comparison of conventional film and digital radiography in the proximal caries diagnosis. Materials and Methods: In this in vitro study, 60 extracted premolar teeth were selected and mounted in acrylic blocks. The teeth were radio- graphed using F-speed film and a complementary metal oxide semiconductor digital sensor (CMOS). Two observers evaluated interproximal surfaces for detection of presence and extent of caries. True caries depth was determined by his- tological examination. The diagnostic accuracy of each radiographic system were assessed by means of receiver operating characteristic curve (ROC) analysis. Results: There was no significant difference be- tween two imaging modalities. The AZ values in cases without caries and dentinal caries were greater than caries restricted to enamel and Den- tino Enamel Junction (DEJ). The differences among observers also were not statistically sig- nificant. Conclusion: Both imaging modalities were com- parable in the detection of proximal carious le- sions.

Prevalence of Candida spp. during radiographic examination in Diabetes mellitus patients

INTRODUCTION: It is suggested that individuals with diabetes are more susceptible to Candida infections than healthy people, especially if periodontal infection is associated. OBJECTIVE: This study evaluated the prevalence of colonization by Candida spp. during radiographic examination in diabetic and non-diabetic patients. MATERIAL AND METHODS: Twenty-six patients with type 2 diabetes mellitus and 20 patients without diabetes mellitus, presenting chronic periodontitis and presence of Candida spp. in saliva were evaluated. During radiographic examination, samples of saliva were collected from: oral mucosa, conventional radiographic periapical film, digital x-ray sensor (CDR), and bite block of the receptor-positioning device. Colony forming units (cfu/mL) and identification of Candida yeasts were assessed. RESULT: Oral mucosa from both groups showed the highest colonization with Candida spp. if compared with others surfaces collected (p &lt; 0.05). In diabetic patients, the mucosa of the upper left regions showed higher levels of colonization. In non-diabetic patients, the upper right molar region showed the highest level of colonization during the examination of the receptor-positioning device, the sensor and the non-sensitive film. Candida spp. levels in saliva were similar between diabetics (mean = 3.0 × 10(6)) and non-diabetics (mean = 3.8 × 10(6)). CONCLUSION: No difference in Candida spp. colonization (cfu/mL) in diabetics and non-diabetic patients was observed for the five collected surfaces and the simulated radiographic region. Candida albicans was the prevalent species of Candida spp. found on all the samples.

Diagnosis of Simulated External Root Resorption Using Conventional Intraoral Film Radiography, CCD, PSP, and CBCT: A Comparison Study

Diagnosis of external root resorption (ERR) cavities may be challenging, especially when no clinical signs are seen. Therefore, the aim of this study was to compare the efficacy of conventional intraoral film radiography, charge-coupled device (CCD) detector, photostimulable phosphor plate (PSP) detector, and cone beam computed tomography (CBCT) for the detection of ERR. The study sample comprised 54 maxillary first premolars. Cavities were created by using a low-speed handpiece with round diamond burs of 1 mm in diameter. Digital and conventional radiographs were taken from each tooth. Three observers examined all images for the presence of resorption cavities. Data were statistically analyzed with the χ(2) test. The reliability and degrees of agreement were also determined by the mean of Cohen's Kappa analysis. The differences between the imaging methods in correct detection of root resorption for all sizes were not significant. For locations of root resorption, significant differences were found between CBCT and other methods in the apical regions. CBCT was only useful for detection of cavities located in the apical one-third of the root, compared to other digital or conventional methods.

SU-E-T-69: A Novel Method Using Agfa-Kodak- Computer Radiography System for Routine Quality Assurance Tests on Linear Accelerators

Purpose: Since conventional radiographic films are becoming obsolete, we have developed a novel technique utilizing Computer Radiography (CR) plates to perform routine Linac quality assurance checks. Methods: A photostimulable CR plate can detect both direct and indirect ionization radiation, and is even sensitive to photons in the visible range. A technique involving optical bleaching of radiation field on CR plate is being established as the calibration tool for performing routine quality checks such as: light field radiation congruence, symmetric/asymmetric jaw positioning. The CR plate is removed from its cassette with minimal background light and is exposed to a known field size of 6/18 MV photons in air at a fixedsource to surface distance. The jaws are then moved in to form a smaller field size, and light field is then shone on the pre exposed plate. This causes photo bleaching of radiation field proportional to the jaw settings and thereby providing a suitable surrogate to establish the light and radiation coincidence. The plate is then read utilizing a Kodak (ACR 2000i) scanner which reads the photo stimulated luminescence and converts the signal into a digital image pixel map. Analysis using a MATLAB-based algorithm was done to compute the dose gradient at the junction of the light and radiation field. The technique has been tested against conventional methods of usingfilm and graph paper. Results: All light and radiation field measurements using the CR plate were within 1 mm from measurements. The method has been verified for its reproducibility and estimated uncertainty involving software based analysis has been found to be within +/− 0.2%. Conclusions: A method to efficiently, accurately and reproducibly perform routine QA has been developed. The technique has yielded a reproducible method to quantify the congruence between the light and the radiation field.

Diagnostic Accuracy of Digital and Conventional Radiography in the Detection of Non-Cavitated Approximal Dental Caries

Radiography plays an important role in the detection of interproximal caries. The aim of the present study was to determine diagnostic accuracy of chargecoupled devices (CCD), Photo Stimulable Phosphor (PSP) and film radiography in detecting non-cavitated caries. Seventy-two non-cavitated approximal surfaces of extracted human posterior teeth were radiographed under standardized conditions using three intraoral modalities: CCD Dixi3 (Planmeca, Finland), PSP Digora PCT (Soredex, Finland),and E-speed film (Kodak, USA). Radiographs were interpreted by four observers and caries lesions were classified as sound (R0), restricted to enamel (R1), reaching the dentinoenamel junction (DEJ) and the outer half of the dentin (R2) and the inner half of the dentin (R3). The teeth were subsequently sectioned for histological analysis which served as the gold standard for radiographic examination. Microscopic examinations showed that the distribution of caries were 63.9% sound, 18.1% enamel, 9.7% DEJ and outer half of the dentin and 8.3% into the inner half of the dentin. The sensitivity and specificity of film, CCD and PSP for the detection of enamel caries were 38% and 98%; 15% and 96 %; and 23% and 98%, respectively. The sensitivity and specificity of film, CCD and PSP for the detection of both dentin and enamel caries were 55% and 100%; 45% and 100% ; and 55% and 100%, respectively. The results demonstrated that the diagnostic accuracy of digital images is similar to that of conventional film radiography in the detection of non-cavitated approximal caries.

Assessment of endodontically treated teeth by using different radiographic methods: an ex vivo comparison between CBCT and other radiographic techniques

PurposeTo compare different radiographic methods for assessing endodontically treated teeth.Materials and MethodsRoot canal treatments were applied in 120 extracted mandibular teeth, which were divided into four groups: (1) ideal root canal treatment (60 teeth), (2) insufficient lateral condensation (20 teeth), (3) root canals filled short of the apex (20 teeth), (4) overfilled root canal treatment (20 teeth). The teeth were imaged using intraoral film, panoramic film, digital intraoral systems (CCD and PSP), CCD obtained with portable X-ray source, digital panoramic, and CBCT images obtained at 0.3 mm3 and 0.2 mm3 voxel size. Images were evaluated separately by three observers, twice. Kappa coefficients were calculated. The percentage of correct readings obtained from each modality was calculated and compared using a t-test (p<0.05).ResultsThe intra-observer kappa for each observer ranged between 0.327 and 0.849. The inter-observer kappa for each observer for both readings ranged between 0.312 and 0.749. For the ideal root canal treatment group, CBCT with 0.2 mm3 voxel images revealed the best results. For insufficient lateral condensation, the best readings were found with periapical film followed by CCD and PSP. The assessment of teeth with root canals filled short of the apex showed the highest percentage of correct readings by CBCT and CCD. For the overfilled canal treatment group, PSP images and conventional periapical film radiographs had the best scores.ConclusionCBCT was found to be successful in the assessment of teeth with ideal root canal treatment and teeth with canals filled short of the apex.

Role of Radiologic Imaging in Irritable Bowel Syndrome: Evidence-based Review

To critically evaluate the current literature in an effort to establish the current role of radiologic imaging (computed tomography, magnetic resonance imaging, ultrasonography [US], fluoroscopy, conventional film radiography) in irritable bowel syndrome (IBS). The term "irritable bowel syndrome" was used to search Clinical Evidence, UpToDate, Cochrane Library, TRIP, and National Institute for Health and Clinical Excellence databases and the American College of Physicians Journal Club and Evidence-Based Medicine online. PubMed was searched by using medical subject headings ("irritable bowel syndrome;" "colonic diseases, functional;" "diagnosis;" "colonography;" "computed tomographic (CT)") and the dates January 1, 1985 to July 1, 2010. Appraisal was independently performed by two reviewers who followed the Oxford Centre for Evidence Based Medicine practice criteria. No systematic review (SR) specifically examined radiologic imaging in IBS; however, in the secondary literature, five relevant SRs or guidelines partially addressed this topic. A PubMed search identified 1451 articles, 111 of which at least partially addressed radiologic imaging. Of these, seven valid articles (two SRs and five primary research articles) were identified. The five primary research articles examined either colonic investigations (colonoscopy and barium enema examination) (n=5) or US (n=2) or both (n=2). Structural disease found infrequently in patients with IBS-type symptoms included diverticulosis, colorectal cancer, celiac disease, inflammatory bowel disease, and ovarian cancer. The incidence of structural disease in patients with concerning symptoms was low. Although widely used, there is a surprising paucity of evidence guiding radiologic imaging in IBS. Radiologic imaging may not be required in patients with IBS without potentially concerning symptoms but should be considered where such symptoms exist, and choice of imaging study should be influenced by predominant symptoms. Definitive recommendations must await further research.