Number Of X-ray Examinations Research Articles

Proposals for Improving the System of Radiation Safety in Medical Exposure. Part 1. Analysis of information contained in state reporting forms and information databases in Moscow

The aim of the search was to compare the sources of information and evaluate dynamics of changes of the patients doses during x-ray and radionuclide examinations in medical organizations in Moscow from 2017 to 2020. Material and methods: Reporting forms № 3-DOZ, № 30 and Radiation-Hygienic Passport for 2017–2020 from Moscow organizations of different forms of ownership were collected and analyzed. The analysis was performed of the main indicators that determine the radiation safety in medical exposure: the number of medical organizations operating sources of ionizing radiation, the equipment of radiation diagnostics, the structure of radiation diagnostics and collective doses from medical exposure. Results: The analysis of trends of the development of radiation diagnostics in Moscow presented in the paper shows that the number of organizations operating ionizing radiation sources is increasing every year; the number of computed tomography scanners is growing by an average of 10% per year, and there is approximately the same increase in the number of computed tomography examinations. Therefore, in 2017-2019 the annual increase in the number of examinations was 10%; it was 30% in 2019–2020, which is associated with the epidemic of the new coronavirus infection COVID-19. The increase in the collective dose from medical exposure corresponds to the increase in the number of X-ray examinations. Comparison of the considered reporting forms and data from the unified X-ray information system shows that all reporting forms have their advantages and disadvantages, which are discussed in detail in the paper. For a comprehensive assessment of the condition of radiation diagnostics, it is necessary to compile data from different statistical reporting forms, which negatively affects the reliability and representativeness of the data. It should be noted that all the considered statistical reporting forms provide no data on individual and accumulated patients doses, as well as standard (typical) doses for the equipment of X-ray and radionuclide diagnostics. The existing procedure of data collection does not allow to receive and analyze the data online. Conclusion: Among the analyzed statistical reporting forms, there is no one that fully provides the tasks of the current assessment of the situation and operational management of public radiation doses. Some of the data in fact duplicate each other, and the existing discrepancies are more likely express difficulties in collecting and summarizing information than differences in reporting forms. Current statistical reporting forms require revision, consolidation, clarification and automation of data collection processes. Further implementation of electronic systems for recording and controlling patients doses, and generation monitoring and reporting systems, as well as interdepartmental interaction systems and the creation of an electronic office of organizations will reduce the rate of non-submission of reporting documentation. That makes it more objective and provides all the data necessary to optimize radiation protection of patients.

Radiation-hygienic monitoring and assessment of the doses of the public residing on the radioactively contaminated territories of the Tula region

Aim of the study: analysis of the results of the radiation-hygienic monitoring of the territories of the Tula region, contaminated due to the Chernobyl NPP accident; concentration of 137Cs and 90Sr in the locally produced food products and analysis of the annual effective dose of the public. Materials and methods: the study was performed in the Tula region in 1997-2018. It included the evaluation of the indicators of the radiation safety of more than 50 thousand samples of the main food products, sampled in the areas of the radioactive “Chernobyl” contamination of the region with the simultaneous measurement of the external gamma-radiation dose rate in the stationary control points. Additionally, it included the assessment of the dynamics of concentration of 137Cs and 90Sr in food products, maximal values of mean annual effective doses of the public and contribution of the collective dose from medical exposure into the structure of the annual collective dose of the public. Results: The study allowed estimating the concentration of 137Cs and 90Sr in the main local food products. Estimated values of gamma radiation dose rate were stable and laid in the range of normal variations specific to the middle latitudes of the European part of Russia. The values of maximal mean annual effective doses of the public indicate the stable radiation environment and do not exceed 1 mSv. It should be mentioned that the contribution of collective dose from medical exposure into the annual collective dose of the public as well as the values of mean individual effective doses from medical exposure are reducing with the increase in the number of X-ray examinations. Conclusions: The lack of exceedances of the permissible levels of 137Cs and 90Sr in the locally produced food products and the reduction of the mean annual effective dose of the public indicates the possibility of the transfer of the settlements affected by the Chernobyl NPP accident into the normal living conditions within the program of the transfer of the settlements from the “Chernobyl” zone.

Three-year clinical application practice report of lung ultrasound in our NICU

Objective To retrospectively analyze the application of lung ultrasound in neonatal department of our hospital in the past three years, and summed up the clinical diagnosis and treatment changes brought by it. Methods The clinical data of infants accepted the bedside lung ultrasound examination from May to December 2016(early carry out stage), from January to December 2017(adaptation stage), from January to August 2018(normal conduct stage) in our NICU of Jingzhou Central Hospital were collected.The clinical data of 878 infants with different stages of application were compared and analyzed. Results In 878 children, 1 225 of lung ultrasound were performed, 64.1% of patients had pulmonary disease, and 35.9% had no lung disease.There were 67 cases of neonatal respiratory distress syndrome, 278 cases of wet lung, 259 cases of pneumonia, 64 cases of meconium aspiration syndrome, 72 cases of acute respiratory distress syndrome, 63 cases of atelectasis and 14 cases of pleural effusion.A total of 1 122 times of lung X-ray examination were performed in 878 children.The number of X-ray examinations per capita decreased from 2.48 times in 2016 to 1.40 times in 2017 and 0.84 times in 2018.A total of 32 times of pulmonary CT examination were performed.The number of lung CT inspection decreased from 0.060 times in 2016 to 0.038 times in 2017 and 0.029 times in 2018.Lung ultrasound was convenient for dynamic observation, and could be used to determine the improvement, aggravation or new pulmonary lesions. Conclusion Lung ultrasound is accurate in the diagnosis of lung disease in NICU, especially for children with long hospital stay, repeated illness and difficult to withdraw.It is easy to carry out in clinic, at the bedside, which can reduce the times of chest X-ray and CT per capita examination.Lung ultrasound is an effective and feasible method for NICU to diagnose lung diseases and it is worth promoting. Key words: Newborn; Lung ultrasound; Chest X-ray; Lung CT

DOSE EVALUATION FOR DIGITAL X-RAY IMAGING OF PREMATURE NEONATES.

X-ray radiography is a commonly used diagnostic method for premature neonates. However, because of higher radiosensitivity and young age, premature neonates are more sensitive to the detrimental effects of ionising radiation. Therefore, it is important to monitor and optimise radiation doses at the neonatal intensive care unit (NICU). The number of x-ray examinations, dose-area product (DAP) and effective doses are evaluated for three Dutch NICUs using digital flat panel detectors. Thorax, thorax-abdomen and abdomen protocols are included in this study. Median number of examinations is equal to 1 for all three hospitals. Median DAP ranges between 0.05 and 1.02 μGy m2 for different examination types and different weight categories. These examinations result in mean effective doses between 4 ± 4 and 30 ± 10 μSv per examination. Substantial differences in protocols and doses can be observed between hospitals. This emphasises the need for up-to-date reference levels formulated specifically for premature neonates.

Abdominal imaging utilization in the emergency department: trends over two decades

BackgroundTo assess patterns of use of abdominal imaging in the emergency department (ED) from 1990 to 2009.MethodsWe retrospectively reviewed data on adult ED patients treated between 1990 and 2009 at our university-affiliated quaternary care institution. Examinations were coded by abdominal imaging modality: x-ray, sonography, CT, or MRI. Proportional costs for each imaging modality were evaluated using relative value units (RVUs). Chi-square tests were used to assess for significant trends.ResultsThe intensity of abdominal imaging per 1,000 ED visits increased 19.3% from 1990-2009 (p = 0.0050). The number of abdominal CT scans per 1,000 ED visits increased 17.5-fold (p < 0.0001). Similarly, the number of abdominal MRIs per 1,000 ED visits increased from 0 to 1.0 (p < 0.0001), and the number of abdominal sonographs per 1,000 ED visits increased 51.6% (p = 0.0198). However, the number of x-ray examinations per 1,000 ED visits decreased 81.6% (p < 0.0001). Abdominal imaging RVUs per 1,000 ED visits increased 2.7-fold (p < 0.0001), due primarily to CT imaging, which accounted for 14% of RVUs in 1990 and 76% of RVUs in 2009.ConclusionsThe intensity of abdominal imaging examinations per 1,000 ED visits and the number of abdominal imaging RVUs increased significantly over a 20-year period. CT replaced x-ray as the most common abdominal imaging modality for evaluation of ED patients. In light of these increasing costs as well as the increased radiation exposure of CT, clinical decision rules and computerized decision support may be needed to ensure appropriate utilization of abdominal CT in the ED.

RELIABILITY AND VALIDITY OF CLINICAL AND ULTRASOUND EXAMINATIONs OF DEVELOPMENTAL DYSPLASIA OF THE HIP

Developmental dysplasia of the hip (DDH) is the most common congenital deformation of the musculoskeletal system and its successful treatment is closely related to early diagnosis. The study is aimed at examining the incidence of developmental dysplasia of the hip (DDH) and at analysing the validity of clinical examination, which is used for the early detection of DDH in the neonatal period, compared to ultrasound examination. The study involved 400 neonates born in the Banja Luka Region. A new questionnaire was open during the first regular ultrasound and clinical examination of the neonates’ hips and anamnestic and clinical data were recorded in it: the asymmetry of the gluteal, inguinal and femoral folds (Bade sign), the result of abduction test separately for each hip, the Ortolani sign of luxation and the Palmen sign of reposition, then hip sonography. A Toshiba ultrasound machine with a 7.5 MHz linear probe was used. The method employed was Professor Reinhard Graf’s. Out of the total number of the children with a positive sonographic finding for DDH, 63.16% of them have one of the clinical signs of DDH. The ability of a clinical finding to identify those patients who do not have DDH and have a negative sonographic finding is 79.8%. Out of the total number of the examined children with a positive clinical finding, only 15.58% of them also have a positive sonographic finding for DDH. This research has showed that clinical examination of the hips is of low sensitivity, specificity and reliability, and that not all types of DDH can be detected. Clinical examination must remain an integral part of every infant’s examination, but it constitutes a complementary diagnostic procedure to ultrasound examination. The ultrasound examination of DDH has created new possibilities and has filled the void that existed due to the deficiency of clinical tests, and at the same time it has reduced the number of X-ray examinations of the hips. This research has confirmed that clinical examination of the hips does not meet the screening criteria. It must remain an integral part of an infant’s examination because it, among other things, provides the information which enables the orthopaedic surgeon to choose the most beneficial therapeutic procedures in DDH treatment. Acta Medica Medianae 2011;50(1):26-31.

Is digital better in dental radiography?

In Slovenia, dental radiography was the first field in which projection x-ray imaging using digital detectors was done. At present around 30% of intraoral dental x-ray units use digital detectors. Annual test results were analysed to compare digital systems with film-based ones. The survey results show significantly lower doses of exposure in digital systems. In our opinion digital systems are especially suitable for practitioners who perform a low number of x-ray examinations (e.g. private dentists), because of problems that may arise due to developing a limited number of films. The problem with digital systems could be the ease of deleting an image and performing another examination, the extent of which was not investigated.

EXPOSURE OF THE SWISS POPULATION BY RADIODIAGNOSTICS: 2003 REVIEW

A nationwide investigation was conducted in Switzerland to establish the exposure of the population by medical x rays and update the results of the 1998 survey. Both the frequency and the dose variations were studied in order to determine the change in the collective dose. The frequency study addressed 206 general practitioners (GPs), 30 hospitals, and 10 private radiology institutes. Except for the latter, the response rate was very satisfactory. The dose study relied on the assessment of the speed class of the screen-film combinations used by the GPs as well as the results of two separate studies dedicated to fluoroscopy and CT. The investigation showed that the total number of all medical x-ray examinations performed by GPs registered a 1% decrease between 1998 and 2003, and that the sensitivities of the film-screen combinations registered a shift towards higher values, leading to a reduction of the dose delivered by a GP of the order of 20%. The study indicated also that the total number of all x-ray examinations performed in hospitals increased by 4%, with a slight increase of radiographies by 1% but significant decrease of examinations involving fluoroscopy (39%), and a 70% increase for CT examinations. Concerning the doses, the investigation of a selection of examinations involving fluoroscopy showed a significant increase of the kerma-area product (KAP) per procedure. For CT the study showed an increase of the dose-length product (DLP) per procedure for skull and abdomen examinations, and a decrease for chest examination. Both changes in the frequency and the effective dose per examination led to a 20% increase in the total collective dose.

Cytogenetic analysis of Greek farmers using the micronucleus assay in peripheral lymphocytes and buccal cells.

The potential cytogenetic damage associated with pesticide use in Greek agricultural workers was evaluated using micronuclei (MN) as biomarkers in lymphocytes of peripheral blood and exfoliated cells of the buccal mucosa. In addition, the effects of pesticide exposure and other variables on the cytokinesis block proliferation index (CBPI) in lymphocytes were also evaluated. Both the exposed and control individuals were selected from Nea Makri, a village near Athens (Greece). This location was selected for its high greenhouse density. Micronuclei were analysed in 50 agricultural workers exposed to pesticides (30 men and 20 women) and in 66 non-exposed individuals that constituted the control group (41 men and 25 women). The comparison between workers and controls did not reveal any statistical significant difference in the MN frequency for either lymphocytes or buccal cells. Nevertheless, the multiple regression analysis revealed that the age and the interaction between gender and the number of X-ray examinations during the last 3 years preceding the sampling increased the number of MN in lymphocytes. Moreover, the results of the negative binomial regression analysis suggested that the level of MN in buccal cells could be reduced by the intake of fish, whilst being increased by olive oil consumption. Regarding CBPI, the value found in the exposed group was lower than in controls, the difference being statistically significant. On the other hand, CBPI was inversely associated with both age and X-ray exposure.

The distribution of medical X-ray doses amongst individuals in the British population

This study has estimated the distribution of diagnostic X-ray doses amongst individuals in the British population by sampling the records kept by general practitioners (GPs) on their patients and the records held by the radiology department of a district general hospital. Deceased patients were chosen in the former case in order to evaluate the dose acquired over a complete lifetime. In each case, several hundred records were sampled. The GP data obtained have enabled an estimate to be made of the likelihood of reaching various dose levels in a lifetime. It is estimated that about 1% of the population has received a lifetime effective dose-equivalent of more than 100 mSv. The largest cumulative dose revealed by the samples of GP and radiology department records was about 200 mSv. The GP data have also shown that the last year of life sees a four-fold increase in the number of X-ray examinations experienced compared with the previous 9 years. The hospital data have allowed an estimate to be made of current rates of dose acquisition amongst the population of a District Health Authority.

M. Legg-Calvé-Perthes. Wertigkeit der MRT in der Frühdiagnostik und Verlaufsbeurteilung

We report on the value of MRT in diagnosis and follow-up of Perthes' disease. 38 children who were clinically suspect of suffering from Perthes' disease were examined by conventional x-ray and MRT. 25 children were proven to have Perthes' disease, 12 of them in an early stage. During the onset of the disease MRT showed a higher sensitivity (58% vs 50%) and accuracy (74% vs 71%) than conventional x-ray while specificity was equal (83% for both). Additionally, MRT in combination with the still obligatory x-ray gave no false-positive results. In some cases, the diagnosis may be found up to 6 weeks earlier using MRT. Conservative therapeutic regimens obviously will not profit from this. Although excluding other diseases is certainly helpful, the value of MRT as a primary diagnostic procedure is limited. During follow-up, MRT helps to reduce the number of x-ray examinations since it can easily assess the containment of the hip and the bone marrow revitalisation. Scintigraphy, another valuable method to judge revitalisation, should remain limited to selected cases, as it requires significant amounts of radiation.

Effective Dose Equivalent and Associated Risks from Mass Chest Radiography in Kuwait

The number of x-ray examinations performed on persons undergoing mass chest radiography in Kuwait reached a maximum of 1.858 X 10(5) in 1982 with miniature radiography (70 mm) claiming more than 90% of the total number and the rest done with the large film technique. The annual prevalence of asymptomatic tuberculosis patients diagnosed by x rays, as reported by the project statistics, does not, in our opinion, justify exposing such a large population. In this paper, the effective dose equivalent is calculated from both miniature and large film mass chest radiography as applied in Kuwait. The values obtained are 283 mu Sv and 35.5 mu Sv, respectively. These figures yield calculated risks of fatal malignancies per examination of 3.37 X 10(-6) and 0.422 X 10(-6), respectively. The annual collective effective dose equivalent to the population undergoing mass chest radiography in Kuwait during the 7 y 1977-1983 is found to vary between 38-48 man-Sv. These figures are used to calculate an average of 0.5 additional cases of fatal malignancies per year, or about 12 excess fatalities in the forthcoming 25-y period if the number of mass chest x-ray examinations stays at its existing level. A total of 98% of these calculated excess fatalities result from the predominant technique, miniature radiography.

Structural polymorphism of (1→4)—β— d—Xylan

A number of X-ray examinations on (1 -+ 4)--13--D--xylantype materials have been reported over the years 1 v Although the source of xylan varies, all crystallographic data are in good agreement with the structure proposed by Nieduszynski and Marchessault 1 for the xylan hydrate. The structure was a hexagonal unit-cell with the chains in a threefold helical conformation stabilized by water molecules. It was noticed that cell parameters were sensitive to hydration conditions 6, but in the hydrated state, where best crystallinity is achieved, all (1 -+ 4)--13-D--xylans crystallize in the hexagonal unit-cell structure. Except for the hydrate and dry forms, no other polymorphs are known for (1 --* 4)/3-D-xylan. The authors have obtained single crystals of a new polymorph of (1 -+ 4)-/3--D--xylan and are reporting, herein, crystallographic data obtained from electron and X-ray diffraction. Xylan was extracted from esparto grass according to the method described by Chanda et a l . . Procedures described by Marchessault et a/.gto obtain hexagonal xylan single crystals were used. A 0.05% (w/w) aqueous suspensiol of linear, acid-free xylan was autoclaved at 120°C for 4 h and cooled to room temperature. The clear solution then crystallized after 6 to 48 h. After centrifugation and washing with water, observation of the sediment by electron microscopy revealed hexagonal single crystals of the type shown in Figure la. The crystals are similar to those obtained by Marchessault et al. 9 and the electron diffraction pattern (Figure ]c) corresponds to that of Atkins et al. 12 It can be indexed on a trigonal array and corresponds to a real lattice spacing ofa = b = 9.2 A. This value is in good

Reasons for requesting radiographs in an accident department.

A prospective study of 500 patients was performed to determine the reasons for requesting radiographs in an accident and emergency department. Most examinations were requested either to confirm a clinically suspected abnormality or because of difficulty in excluding a significant bone injury on clinical grounds alone. Several requests were also made to reassure the patient. Medicolegal reasons were relatively few, and those made purely because the doctor feared litigation probably accounted for only 5% of requests. Undue emphasis on the medicolegal aspects of accident and emergency radiography in the United Kingdom is unhelpful in that it directs attention away from the real reasons for x-ray referral. Although a reduction in the number of x-ray examinations is desirable on the grounds of expense and radiation exposure it is likely to be obtained only by improving experience and acumen in the clinical assessment of injuries.

Radiological Diagnosis of Lumbar Intervertebral Disc Lesions

The literature so far published on the X-ray appearances of the lumbo-sacral region in cases of intervertebral disc protrusions presents a considerable divergence of views. A difference of opinion exists on the value of straight radiography for the diagnosis of disc lesions; and spinal contrast injections are considered essential by some workers whilst others condemn its use. The findings in this report are based on a large number of X-ray examinations of the spine and on 160 laminectomies with verified disc lesions. There are several problems for consideration. Is the use of myelography justified in the diagnosis of disc lesions? If, on the strength of our present knowledge, myelography should be condemned, how far does the ordinary examination of the lumbar spine help in the diagnosis? Are there any straight radiological signs in disc lesions? What other differential diagnostic possibilities exist? Lastly some points of X-ray technique will have to be considered. The majority of radiological papers deal...

The Examination and Tests of Welded Parts for Steam Power Plant

The object of the paper is to give the results of certain experimental and routine inspection work rather than to lay down rules of inspection and testing. An outline is given of the margin obtained between some of the properties and requirements of actual drums and the specified limits. European practice appears to favour acetylene welding for the butt welding of tubes. Normally acetylene welds do not suffer from basal cracking, but they do suffer from lack of penetration; the paper gives methods by which this can be avoided, and suggests forms of joints for tubular welds. The inspection of tubular welds presents many problems, but certain non-destructive tests have been successfully applied, and a number of X-ray examinations on site are described. A useful method of inspecting large numbers of tubular welds by sample consists in carrying out a reverse bend test on a tongue sawn out of the tube and pressed round a former. The paper also contains the results of extensive experience of the heat treatment of welds on site.