Preliminary Radiographs Research Articles

The scanning grid: a novel and effective bucky movement.

A grid consisting of a focused array of radiopaque strips has been constructed. No interspace material is employed, and, during an exposure, the arrangement moves so that the grid strips remain focused and a uniform film density is obtained. Preliminary measurements and radiographs of patients indicate that such a device is a practical and effective method of suppressing scatter.

A simple method of localizing the level of computed tomography cross sectioning.

Before computed tomography (CT) scanning, a preliminary radiograph of the area of interest is obtained with a Bell-Thompson ruler on the table top parallel to the spine. This allows precise localization of the level of CT sectioning in relation to the vertebral column.

Modification of a stereotaxic guide for trans-nasal pituitary ablation.

Abstract A stereotaxic guide (the Todd-Wells apparatus) has been modified for use with a mobile X-ray image intensifier to allow rapid and precise positioning of a cannula within the pituitary fossa. The sagittal plane of the sella is determined in relation to external, radio-opaque skin markers by preliminary radiographs. The C-arm of the image intensifier is aligned with the sagittal plane of the hemicircular sighting arc of the stereotaxic frame. The patient's skull is fixed to the frame and rotated beneath the sighting arc until the sagittal planes of the sella and arc coincide. The intensifier C-arm is then linked in the horizontal position to the sighting arc by an extension bar and electromagnetic brakes. The patient's head and lateral sighting assembly are moved during screening until the centering mark lies at the chosen point within the sella. A surgical cannula represents a radius of the sighting arc and is passed through the nasal cavity and across the sphenoid bone to this point within the se...

A Preliminary Radiographic Study of the Time of Appearance of the Loci of Ossification of the Distal Sesamoids of the Young Calf

SUMMARY A preliminary radiographic study of 12 Ayrshire calves was made to ascertain the time of appearance of the locus of ossification of the distal sesamoid. Birth dates and service dates where known were recorded. The results indicate that the information may be useful in assessing whether a calf is within the first 2 weeks of postnatal life. The time of appearance of the locus in relation to the service date and date of birth is discussed.

Massive Hemorrhage from Varices of the Duodenal Loop in a Cirrhotic Patient

Massive hemorrhage from the alimentary tract in a cirrhotic patient presents a difficult diagnostic and therapeutic problem. When the bleeding is due to varices they are usually either gastric or esophageal in location. We have recently had the opportunity to study a patient known to have esophageal varices for at least three years, in whom a duodenal varix, well demonstrated by barium meal examination and splenoportography, was largely responsible for the hemorrhage that led to death. Case Report This 65-year-old white man was first admitted to Strong Memorial Hospital in June 1959, after three days of black tarry stools. A long history of alcohol consumption was elicited. Physical examination demonstrated hepatosplenomegaly. Stool and gastric aspirant were strongly guaiac-positive. Hematocrit at admission was 30. The patient continued to pass blood per rectum and required transfusion with 6 units of whole blood over the next few days. Liver function tests demonstrated hepatocellular dysfunction. An upper gastrointestinal series revealed esophageal varices (Fig. 1A). The stomach, duodenal bulb, and duodenal loop (Fig. 2A) appeared normal. Esophagoscopy failed to confirm the presence of varices. After the insertion of a Sangstacken tube, however, the bleeding stopped and the patient's hematocrit became stabilized. He was discharged after seventeen days of hospitalization. For the next three years, the patient was apparently well although he drank about one pint of wine each day. Four days prior to his second and final admission to the hospital he again bled per rectum. On admission the hematocrit was 36. Laboratory evidence of hepatocellular damage was again found. Gastric aspiration was productive of faintly guaiacpositive material. An upper gastrointestinal series demonstrated esophageal varices (Fig. 1B). The stomach and duodenal bulb were normal. A lobulated defect 2 cm. in diameter was seen in the second portion of the duodenum (Fig. 2B). Later in the same day a splenoportogram was obtained. The preliminary radiograph of the abdomen demonstrated residual barium in the fundus of the stomach and small bowel. Contrast medium in the second portion of the duodenum again outlined the lobulated mass (Fig. 3A). After the injection of 30 c.c. of 50 per cent Hypaque into the splenic pulp both the splenic and portal veins filled. The peripheral radicals of the portal vein had an attenuated appearance. The coronary vein filled. In addition to this, a large vessel, which appeared to be the superior mesenteric vein, was opacified and shown to fill the defect in the duodenal loop (Fig. 3B). Leading from this defect, which was apparently a large varix, another vein coursed to the region of the liver bed. On the basis of these examinations a diagnosis of a varix of the second portion of the loop was made. During the next three days the patient received 22 units of blood.

Measurement of Hg203 chlormerodrin accumulation by the kidneys for detection of unilateral renal disease.

It has long been recognized that a reliable screening procedure is needed for hypertensive patients, in order that a minority whose disease is due to unilateral renal ischemia may be selected. A popular technic for this purpose has been the “radioisotope renogram,” whereby the rate of accumulation and excretion of I131 o-iodohippuric acid2, injected intravenously, is measured by paired scintillation detectors external to the kidneys, (3, 4). Since 1959, the mercurial diuretic chlormerodrin (Neohydrin) labeled with Hg203 has been used for delineation of localized renal lesions by scintillation scanning (2). In addition, renal function may be assessed with this material by measuring its rate of accumulation by a technic similar to the I131 Hippuran studies. To perform this “chlormerodrin uptake test,” the patient is positioned supine on a modified x-ray table tilted 30° from the horizontal. A preliminary radiograph is obtained for accurate localization of two scintillation detectors under the kidneys. The s...

Importance of survey radiograph of the abdomen in surgery

The case of a forty-two year old woman has been presented who over a period of fifteen years had had five abdominal operations with-out benefit of x-ray examination. In spite of her continued complaints and of a presumptive diagnosis of abdominal tumor, this woman was reoperated upon three times without any attempt being made to establish a more definitive diagnosis by means of the roentgen ray. In this particular patient it is pointed out that the simple expedient of a preliminary survey radiograph of the abdomen would have made the diagnosis obvious and would have relieved her of the necessity for probably three useless abdominal operations. The other case was that of a fifty-four year old woman who had a rectosigmoid resection eight months prior to examination at our clinic. A postoperative barium enema examination had been performed at the hospital where she had been operated upon and a diagnosis of “diverticulitis” had been made. A preliminary radiograph of the abdomen would have clearly shown the radiopaque sponge in the pelvis.

Discussion on Cholecystography

(1) No branch of radiology requires more careful attention to technique and detail than gall-bladder radiology.-(2) The X-ray examination should always include (a) a preliminary examination, (b) cholecystography, (c) barium meal, in this sequence.-(3) A number of gall-stones can be shown on the preliminary radiograph, and a further number on the cholecystograph, but there still remains a proportion which cannot be seen by X-ray examination. The greater the care taken in technique, the smaller will be the number of gall-stones not indicated.-(4) The radiographic demonstration of gall-stones does not necessarily mean that the lesion causing the patient's illness has been discovered. Gall-stones may exist without causing marked symptoms. They may produce symptoms which are atypical.-(5) The dye can be administered (i) by the mouth, (ii) intravenously. The former is now the best routine method of examination, though the latter still remains the more accurate.-(6) Non-filling of the gall-bladder in about 96% of cases indicates a pathological condition of the gall-bladder, often accompanied by stones, though these may not be shown on the radiograph.-(7) Poor filling of the gall-bladder on repeated examination also indicates a pathological condition of the gall-bladder. (8) A good gall-bladder shadow, which is normal in shape, size and position, uniform in outline and density, which contracts after a meal to a much smaller size, in a high percentage of cases indicates a normal gall-bladder. A small proportion of such gall-bladders may be diseased, and may even contain a small collection of stones.-(9) Any abnormality in the area of the gall-bladder before or after it has been filled with dye should be investigated by further radiographs taken according to the type of abnormality seen. (10) It has been demonstrated that a large collection of gall-stones in the gall-bladder can be passed into the intestine by way of the ducts.-(11) Complete gall-bladder radiology enables us to give a fairly accurate opinion as to the condition of the gall-bladder.