Role Of Plain Radiography Research Articles

The Role of Plain Radiography in Assessing Aborted Foetal Musculoskeletal Anomalies in Everyday Practice.

Conventional radiography is widely used for postmortem foetal imaging, but its role in diagnosing congenital anomalies is debated. This study aimed to assess the effectiveness of X-rays in detecting skeletal abnormalities and guiding genetic analysis and counselling. This is a retrospective analysis of all post-abortion diagnostic imaging studies conducted at a centre serving a population of over 300,000 inhabitants from 2008 to 2023. The data were analysed using descriptive statistics. X-rays of 81 aborted foetuses (total of 308 projections; mean: 3.8 projections/examination; SD: 1.79) were included. We detected 137 skeletal anomalies. In seven cases (12.7%), skeletal anomalies identified through radiology were missed by prenatal sonography. The autopsy confirmed radiological data in all cases except for two radiological false positives. Additionally, radiology failed to identify a case of syndactyly, which was revealed by anatomopathology. X-ray is crucial for accurately classifying skeletal abnormalities, determining the causes of spontaneous abortion, and guiding the request for genetic counselling. Formal training for both technicians and radiologists, as well as multidisciplinary teamwork, is necessary to perform X-ray examinations on aborted foetuses and interpret the results effectively.

A Hospital based study of High Resolution Computed Tomography and Conventional Radiography for Evaluation of Pathologies of Temporal Bone

Background: Many imaging modalities have been in use for the evaluation of temporal bone lesions. Plain X-rays are cost-effective however; they provide limited details and hence sometimes may result in an inaccurate diagnosis. With the advent of HRCT, the method of imaging of temporal bone has evolved with special algorithms and multiplanar formats. In the present study, we tried to evaluate the different pathologies of the temporal bone with X-ray and HRCT. Methods: The study was conducted in the Departments of Otorhinolaryngology and Radiology, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. A total of n=40 patients were identified and selected based on their symptoms and clinical findings suggestive of a lesion involving the temporal bone such as Otalgia, Otorrhoea, And Sensorineuronal deafness, pulsatile tinnitus, vertigo, and giddiness. These patients were subjected to high resolution computed tomography of the temporal bone on the 128 Slice CT Scanner (PHILIPS INGENUITY). The patients also underwent plain Radiography of temporal bone (CARESTREAM DRX-1 System). Results: Of the total n=40 patients studied the most common temporal bone disease was due to inflammation 85% and tumors were found in 15% of the patients. The common site of involvement of middle ear and mastoid air cells in chronic otitis media was epitympanum in n=30(90%) of cases, Mesotympanum in n=20(60%) of cases. In diseased ears, radiographs of the mastoids revealed pneumatised mastoid in 6(15%), diploic in 6(15%), and sclerosed mastoid in 28(70%) cases. HRCT temporal bone revealed pneumatised mastoid in 9(22.5%), diploic in 5(12.5%) and sclerosed mastoid in 26(65%) cases. Conclusion: The role of plain radiography is found to be limited to know the type of mastoid pneumatisation. It can also as Original Article detect bony erosion in few cases. Because of the ability to see temporal bone structures with great clarity, HRCT can be recommended not only in cases suspected with potential complications but also in all cases of temporal bone pathologies to know the extent of disease, inter-relationships of the tympanomastoid compartment with adjacent neurovascular structures, varied pneumatisation and the presence of anatomical variations, which should alert the clinician and guide in surgical approach and treatment plan.

Role of Plain Radiography in the Assessment of Ingested Foreign Bodies in the Pediatric Patients

Ingestion of various types of foreign bodies (FBs) such as coins, toy parts, jewelry pieces, needles and pins, fish and chicken bones, and button-type batteries is common among children. The curiosity of children and their need to investigate the world around them place them at a higher risk for ingestion of FBs. Fortunately, 80%-90% of ingested foreign objects that reach the stomach will pass uneventfully without intervention. The remainder may become blocked in the esophagus or other region of the alimentary tract, placing the pediatric patient at risk of significant complications such as aspiration, obstruction, bleeding, perforation, fistulization, sepsis, and death. The goals of the initial pediatric patient assessment are to identify the type of object ingested, its location in the gastrointestinal tract, and the presence of associated complications. Factors reported to increase the risk of complications included a sharp FB, a FB with a wide diameter, and symptoms. Plain radiographs still play an important role in the assessment of ingested FBs in the pediatric patient: plain films of the neck, chest, and abdomen are very useful in confirming the diagnosis of FB ingestion because most ingested FBs are radiopaque.

The Role of Plain Radiography in Predicting Renal Stone Fragmentation by Shockwave Lithotripsy in the Era of Noncontrast Multidetector Computed Tomography

The objective of this study is to determine if plain radiography has a role in prediction of stone fragmentation by shockwave lithotripsy (SWL). Our study included 106 patients undergoing SWL for renal stones. Based on plain radiography criteria, stones were classified according to density, homogeneity, and outline. We compared the success of SWL in fragmentation of stones with a density equal to or less than bone, nonhomogeneous stones, and stones with irregular outline to its success in stones with a density more than bone, homogeneous stones, and stones with smooth outline. In plain radiography, stone density equal to or less than bone, nonhomogeneous stones, and stones with irregular outline showed successful SWL fragmentation in 88.8%, 91.2%, and 90.6%, respectively. Stones with a density more than bone, homogeneous stones, and stones with smooth outline showed successful SWL fragmentation in 52.9%, 52.6%, and 57.1%, respectively. CT attenuation value was significantly less in stones successfully fragmented by SWL compared with nonfragmented stone (649±169 and 1465±256, respectively). In homogeneous stones with smooth outline having a density more than bone, we found a significantly lower CT attenuation in patients with successful stone fragmentation by SWL compared with those with failed stone fragmentation (690.9±171 and 1462±212, respectively). In relatively large solitary renal pelvic stones, plain radiography can predict the success of stone fragmentation by SWL. Nonhomogeneous stones with irregular outline and a density equal to or less than bone are expected to be successfully fragmented by SWL. Noncontrast CT is only needed, to predict success of SWL, in cases of homogeneous stones with smooth outline and density more than bone.

Role of plain radiography and CT angiography in the evaluation of obstructed total anomalous pulmonary venous connection

Obstructed total anomalous pulmonary venous connection (TAPVC) is frequently misdiagnosed as pulmonary disease and without operative correction early death is common. It is important to make a correct diagnosis before surgery. The purpose of this study was to describe the chest radiographic features of obstructed TAPVC and compare CT angiography with transthoracic echocardiography in the evaluation of obstructed TAPVC. Eighteen children with obstructed TAPVC were assessed. Their clinical and imaging data were retrospectively reviewed. The characteristic radiographic findings were analyzed and compared with surgical results, and the diagnostic accuracy of CT angiography and transthoracic echocardiography was evaluated in terms of pulmonary venous drainage and obstruction detection. The common radiographic features included pulmonary venous congestion or edema or both (16 of 18 cases, 89%), and absence of cardiomegaly (12 of 18 cases, 67%). CT angiography correctly diagnosed TAPVC and clearly revealed the draining sites in all children (five with supracardiac TAPVC, three with cardiac TAPVC, eight with infracardiac TAPVC and two with mixed TAPVC). The diagnostic agreement between CT angiography and surgery was 100%. Transthoracic echocardiography only correctly revealed the draining sites in 11 children (5 with supracardiac TAPVC, 2 with cardiac TAPVC and 4 with infracardiac TAPVC). The diagnostic agreement between transthoracic echocardiography and surgery was 61%. The diagnostic accuracy of CT angiography was higher than that of transthoracic echocardiography (P = 0.0156). Thirty-four sites of obstruction were correctly detected by CT angiography (11 in the mediastinum, 1 at the diaphragmatic level, 9 below the diaphragm and 13 stenotic individual pulmonary veins in the lung). The diagnostic agreement between CT angiography and surgery was 92%. Transthoracic echocardiography only correctly detected 15 sites of obstruction (11 in the mediastinum, 1 at the diaphragmatic level and 3 below the diaphragm). The diagnostic agreement between transthoracic echocardiography and surgery was 41%. The rate of detection for sites of obstruction with transthoracic echocardiography was much lower than that of CT angiography (P = 0.0002). In children with obstructed TAPVC, plain radiographs usually show a characteristic pattern of pulmonary venous congestion or edema, or both, and a normal cardiac silhouette. CT angiography is superior to transthoracic echocardiography in the evaluation of pulmonary venous drainage and obstruction, especially in children with infracardiac and mixed TAPVC.

The role of plain radiography in paediatric wrist trauma

ObjectivesAcute wrist trauma in children is one of the most frequent reasons for visiting the emergency department (ED). Radiographic imaging in children with wrist trauma is mostly performed routinely to confirm or rule out a fracture. The aim of this study was to determine how many radiographs of the wrist show a fracture in children following wrist trauma.MethodsA retrospective cohort study was performed in three Dutch hospitals from 2009–2010. Data were extracted from patient records and radiographic reports.ResultsOf the 1,223 children who presented at the ED after a wrist trauma, 51 % had a wrist fracture. The peak incidence of having a wrist fracture was at the age of 10 years; 65 % of the children younger than 10 years of age had a wrist fracture. Of all the patients without a wrist fracture, 74 % were older than 10 years of age.ConclusionAlmost half of the paediatric patients with a trauma of the wrist had normal radiographs. The development of a clinical decision rule to determine when a radiograph of the wrist is indicated following acute wrist trauma is needed. This could likely reduce the number of radiographs.Main Messages Fifty-one percent of the children with wrist trauma have a wrist fracture.Peak incidence of having a wrist fracture is at the age of 10 years.Sixty-five percent of the children younger than 10 years of age had a wrist fracture.Of all the patients without a wrist fracture, 74 % were older than 10 years of age.The development of a clinical decision rule to reduce the number of radiographs is needed.

The role of plain radiography in assessing intussusception with vascular compromise in children

IntroductionIntroduction: The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception.Material and methodsThe hospital notes of 1,119 paediatric cases of intussusception who presented between January 2007 and February 2008 were retrospectively analysed. Informed consent was given by the parents before the air enema and this study was approved by the hospital ethics committee. Overall, the plain abdominal X-rays of 190 cases were assessed independently by two experienced radiologists, and disagreements were settled by discussion. Symptom profiles, operative notes and pathological records were compared to plain radiography. SAS V8.1 was used for the analysis.ResultsOf the 190 patients, 30 cases had vascular compromise on plain films, as shown by the “coffee-bean” sign or “banana” sign. There was a paucity of gas in 36 cases, a quadrant-specific gas pattern in 51 cases, and the film showed a mass in 73 cases. Statistical analysis that compared signs on plain radiography signs and symptom onset showed a significant difference. Ninety-five cases were irreducible by air enema and required surgical intervention. The location of these intussusceptions were ileo-ileal-colic (n = 44), ileo-colic (n = 25), ileo-ileal (n = 14), ileo-caecal (n = 10), and ileo-colic-colic (n = 2). Eleven cases had intestinal necrosis and underwent resection of the necrotic bowel.ConclusionsThe signs of intussusception on plain radiography were significant during the clinical assessment of children with secondary ischaemic bowel. The radiological findings were shown to have a high concordance with pathology in the assessment of intussusception.The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception.

Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy.

The diagnostic imaging of osteomyelitis can require the combination of diverse imaging techniques for an accurate diagnosis. Conventional radiography should always be the first imaging modality to start with, as it provides an overview of the anatomy and the pathologic conditions of the bone and soft tissues of the region of interest. Sonography is most useful in the diagnosis of fluid collections, periosteal involvement, and surrounding soft tissue abnormalities and may provide guidance for diagnostic or therapeutic aspiration, drainage, or tissue biopsy. Computed tomography scan can be a useful method to detect early osseous erosion and to document the presence of sequestrum, foreign body, or gas formation but generally is less sensitive than other modalities for the detection of bone infection. Magnetic resonance imaging is the most sensitive and most specific imaging modality for the detection of osteomyelitis and provides superb anatomic detail and more accurate information of the extent of the infectious process and soft tissues involved. Nuclear medicine imaging is particularly useful in identifying multifocal osseous involvement.

Plain Radiography Versus Computed Tomography Scans in the Diagnosis and Management of Thoracolumbar Burst Fractures

The role of plain radiography in the diagnosis and management of thoracolumbar burst fractures was evaluated when compared with computed tomography (CT) scans. To determine the accuracy of plain radiography in detecting thoracolumbar burst fractures when CT scans were used as the gold standard, and to assess the impact of disagreement of the results between plain radiographs and CT scans on treatment plan. There have been few studies comparing the value of plain radiography with that of CT scans in the diagnosis and management of thoracolumbar burst fractures. Radiographs of 73 patients with a compression or burst fracture were reviewed independently by 3 residents and 3 spine surgeons. The results of CT scans were used as the gold standard to determine the accuracy of plain radiography for the diagnosis. More quantitative results of 57 patients with a burst fracture based on plain radiographs alone were compared with those after addition of CT scans. The disagreement between the results was analyzed, and the impact of disagreement on treatment plan was defined as the changes of load sharing score between <or=6 and >or=7. The accuracy of plain radiography improved with the experience of observers. The results on the load sharing score agreed between plain radiographs alone and radiographs with CT scans only for 56%, indicating moderate agreement. The impact of disagreement on treatment plan was significant (P < 0.05). This disagreement was most contributed by the underestimation for vertebral body comminution based on plain radiographs. The accuracy of plain radiography is acceptable in the qualitative sense, and would improve with the experience of observers. However, plain radiography alone would not be adequate when used for more quantitatively assessing the fractures. Addition of CT scanning is necessary for treatment planning.

Diagnostic Radiographic Findings in Body Packers: A study of 15 Cases in Kuwait

Purpose: To evaluate the role of plain radiography in screening body packers smuggling illicit drugs by concealing it in their gastrointestinal tract and to establish radiological findings in such cases.

Early imaging of spinal trauma

Spinal injury has the ability to maim and kill, but appropriate diagnosis and early treatment should result in minimization of secondary neurological injury and the restoration of the integrity of the spinal column. Rapid early diagnosis is essential and an impressive array of imaging technology is now available to the clinician. However, plain radiography remains the starting point for imaging of patients with potential spinal injury. This article reviews the role of plain radiography and the indications for further imaging, specifically with computerized tomography and magnetic resonance imaging.

The role of plain radiography in the management of suspected orbital blow-out fractures.

We reviewed the indications for radiography and its impact on management in 100 consecutive patients referred to the Radiology Department from the Accident and Emergency Department of a large eye hospital in order to assess the utility of orbital plain radiographs in patients suspected of having blow-out fractures. We assessed whether administration of antibiotics or referral for surgical or orthoptic treatment was influenced by clinical features, radiographic findings or both. Ophthalmologists interpreting the radiographs appeared to be guided by the presence or absence of physical signs. No patient in whom they overlooked a fracture which was not evident clinically was subsequently referred for surgery. All patients who did have surgery for complications of a blow-out fracture underwent pre-operative computed tomography. Neither referral for orthoptic treatment nor administration of systemic antibiotics was consistently influenced by the presence or absence of a fracture. Given these findings, and the observation that the decision to operate was guided exclusively by clinical rather than radiological criteria, we recommend that only patients with well-defined indications for surgery (enophthalmos of more than 2 mm at any time within the first 6 weeks following the injury, and/or diplopia in the primary and/or downgaze reading positions not showing evidence of resolving within 2 weeks of the injury) should undergo radiography.

The Role of Plain Radiography, Computed Tomography, and Magnetic Resonance Imaging in Sarcoma Evaluation

Imaging plays an important role in the diagnosis, staging, treatment planning, and post-treatment monitoring of bone and soft-tissue sarcomas. Plain radiography should be the initial imaging undertaken for patients who present with pain or a mass that may represent a musculoskeletal tumor. This is especially true of bony lesions, in which plain radiography remains the most specific noninvasive means of determining the aggressiveness of a lesion and establishing a working differential diagnosis.