VALIDATION OF A NOVEL TECHNIQUE FOR CREATING SIMULATED RADIOGRAPHS USING COMPUTED TOMOGRAPHY DATASETS

Understanding radiographic anatomy and the effects of varying patient and radiographic tube positioning on image quality can be a challenge for students. The purposes of this study were to develop and validate a novel technique for creating simulated radiographs using computed tomography (CT) datasets. A DICOM viewer (ORS Visual) plug‐in was developed with the ability to move and deform cuboidal volumetric CT datasets, and to produce images simulating the effects of tube‐patient‐detector distance and angulation. Computed tomographic datasets were acquired from two dogs, one cat, and one horse. Simulated radiographs of different body parts (n = 9) were produced using different angles to mimic conventional projections, before actual digital radiographs were obtained using the same projections. These studies (n = 18) were then submitted to 10 board‐certified radiologists who were asked to score visualization of anatomical landmarks, depiction of patient positioning, realism of distortion/magnification, and image quality. No significant differences between simulated and actual radiographs were found for anatomic structure visualization and patient positioning in the majority of body parts. For the assessment of radiographic realism, no significant differences were found between simulated and digital radiographs for canine pelvis, equine tarsus, and feline abdomen body parts. Overall, image quality and contrast resolution of simulated radiographs were considered satisfactory. Findings from the current study indicated that radiographs simulated using this new technique are comparable to actual digital radiographs. Further studies are needed to apply this technique in developing interactive tools for teaching radiographic anatomy and the effects of varying patient and tube positioning.     

MULTISCALE IMAGE PROCESSING AND ANTISCATTER GRIDS IN DIGITAL RADIOGRAPHY

Scatter radiation is a source of noise and results in decreased signal-to-noise ratio and thus decreased image quality in digital radiography. We determined subjectively whether a digitally processed image made without a grid would be of similar quality to an image made with a grid but without image processing. Additionally the effects of exposure dose and of a using a grid with digital radiography on overall image quality were studied. Thoracic and abdominal radiographs of five dogs of various sizes were made. Four acquisition techniques were included (1) with a grid, standard exposure dose, digital image processing; (2) without a grid, standard exposure dose, digital image processing; (3) without a grid, half the exposure dose, digital image processing; and (4) with a grid, standard exposure dose, no digital image processing (to mimic a film-screen radiograph). Full-size radiographs as well as magnified images of specific anatomic regions were generated. Nine reviewers rated the overall image quality subjectively using a five-point scale. All digitally processed radiographs had higher overall scores than nondigitally processed radiographs regardless of patient size, exposure dose, or use of a grid. The images made at half the exposure dose had a slightly lower quality than those made at full dose, but this was only statistically significant in magnified images. Using a grid with digital image processing led to a slight but statistically significant increase in overall quality when compared with digitally processed images made without a grid but whether this increase in quality is clinically significant is unknown.     

Application and possibilities of digital radiography demonstrated on a skull radiograph

The application of digital radiography has not been used widely in veterinary medicine. This paper gives an overview of the possibilities in post processing of digital radiographs for imaging a nasal fracture on a right lateral skull radiograph of a two years old German Shepherd. The following algorithms of the digital ADC (Agfa Diagnostic Center)--system were used: edge-contrast, latitude reduction, noise reduction, window-levelling and MUSI-contrast (MUlti Scale Image Contrast). MUSI-contrast is a recently developed algorithm by Agfa, which improves the recognition of fine details in all scales. These parameters will be explained individually and the use is demonstrated with the skull radiographs. It shows that only a coordinate parameter setting will lead to an optimal image. The option of filtering diagnostic information in using digital post processing represents a clear step forward and reduces the number of repeat shots.     

Comparison of digitized and conventional radiographic images for assessment of hip joint conformation in dogs

OBJECTIVE: To determine agreement between assessments of canine hip joint conformation provided by board-certified radiologists after evaluation of digitized and conventional radiographic images. SAMPLE POPULATION: 200 pelvic radiographs previously evaluated by radiologists using the Orthopedic Foundation for Animals standard grading system for canine hip joint conformation. PROCEDURES: Each of 20 board-certified radiologists evaluated conventional and digitized pelvic radiographs from each of 200 dogs for hip joint conformation. A weighted kappa coefficient and intraclass correlation were used to determine agreement between assessments derived from digitized radiographic images and conventional radiographs and between the original Orthopedic Foundation for Animals conformation ratings and assessments derived from each image format. RESULTS: Overall, agreement between assessments derived from the digitized images and conventional radiographs was good, with all but 1 radiologist attaining a weighted kappa coefficient > 0.61. Intraclass correlation for each radiologist ranged from 0.75 to 0.98 (95% confidence interval, 0.67 to 0.984). On comparison of conformation assessments, 95.7% of those derived from conventional radiographs and digitized images were within 1 grade. On comparison of digitized radiographic conformation assessments and conformation ratings, 94.2% were within 1 grade. On comparison of conventional radiographic conformation assessments and conformation ratings, 92.3% were within 1 grade. CONCLUSIONS AND CLINICAL RELEVANCE: The use of digitized radiographic images does not appear to impact the radiographic assessments of canine hip joint conformation made by consultant radiologists. Compared with conventional radiographs, the use of digitized radiographic images decreases storage space requirements and enables more rapid reporting of assessment results for individual dogs.     

COMPARISON OF THE IMAGE QUALITY OF A HIGH‐RESOLUTION SCREEN–FILM SYSTEM AND A DIGITAL FLAT PANEL DETECTOR SYSTEM IN AVIAN RADIOGRAPHY

A conventional high‐resolution screen–film system was compared with a digital detector system. A total of 20 birds (14 pigeons and six psittacine birds) with an average body mass of 533 g were examined in dorsoventral as well as lateral projections. Digital radiographs were acquired with the same mAs as well as half the mAs used for the conventional radiographs. Three criteria and one overall assessment were defined for each of four anatomic regions and assessed by five veterinarians using a score system. Comparison of the ratings was done by visual grading analysis. For the majority of criteria, there was no significant difference regarding image quality between the digital and screen–film projections. However, for certain criteria the quality of the digital images was significantly superior. Using the same mAs as for the conventional radiographs, the humeral joint surfaces and the honeycomb structure of the lung were assessed as superior with the digital imaging system. The tracheal rings and the delineation of the trachea from the surrounding tissue were also superior with the digital system. Assessment of the trabecular structure of the humerus was superior when the full mAs was used compared with the reduced mAs. In conclusion the digital technique is equal or superior to the conventional screen–film high‐resolution system for pet birds of a medium size. With some limitations, a dose reduction is possible with the digital system.     

COMPARISON OF COMPUTED RADIOGRAPHY AND CONVENTIONAL FILM-SCREEN RADIOGRAPHY OF THE EQUINE STIFLE

Major advantages of computed radiography are the potential reduction of dose and the possibility of postprocessing. In our study, we compared conventional radiographs to digital radiographs of the equine stifle by subjective evaluation of diagnostic quality when using a decreasing photon flux (mAs). Twelve equine stifle joints from horses of different weight and size were examined. Conventional and digital radiographs were performed identically in a caudocranial projection with the tube angled 15 degrees. A series of four radiographs was performed in each technique with an increasing photon flux starting with 2.5 mAs and going up to 5, 10, and 20 mAs. All radiographs were evaluated subjectively in a blinded fashion by seven readers in terms of contrast, bone structure, and diagnostic value and were graded using a 1-5 scale. Results from conventional and digitized radiographs were compared, and differences between the individual observers were analyzed statistically. Contrast, bone structure, and diagnostic value from digital images were rated significantly better than from conventional images (p < .001). For both techniques, a decrease in ranking was found with a decrease of photon flux. There was only slight interobserver variability. A dose reduction up to a factor of 4 compared to a 100 speed film-screen system seems to be possible without loss of information. Weight and size of the horse are not major influences.     

Radiographic techniques for medical-dental research with minipigs

Techniques were developed to obtain standardised intra- and extra-oral radiographs in minipigs for use in medical-dental research. Twelve male minipigs (BR-1 Minipigs) were chosen at random. Two animals each at 3, 5, 7, 9, 12 and 15 months of age were anaesthetised and subjected to radiographic examinations to assess six techniques. Three intra-oral and three extra-oral techniques, standardised for humans, were used with variations of the angle of incidence of the X-ray beams, focus-film distance and exposure time. Two film positioners were developed for the intra-oral techniques. Two examiners then chose the radiographs with the least image distortion, greatest clarity and least superimposition of images. For each technique, the suitable angle of incidence of the X-ray beams, the focus-film distance and exposure time that produced the highest quality radiographs were standardised.     

EVALUATION OF TWO OBJECTIVE METHODS TO OPTIMIZE KVP AND PERSONNEL EXPOSURE USING A DIGITAL INDIRECT FLAT PANEL DETECTOR AND SIMULATED VETERINARY PATIENTS

It is important to optimize digital radiographic technique settings for small animal imaging in order to maximize image quality while minimizing radiation exposure to personnel. The purpose of this study was to evaluate two objective methods for determining optimal kVp values for an indirect flat panel digital detector. One method considered both image quality and personnel exposure as endpoints and one considered only image quality. Phantoms simulated veterinary patients of varying thicknesses with lesions of varying sizes. Phantoms were exposed to a range of kVp values (60, 81, 100, and 121), using different mAs settings for each phantom. Additionally, all phantoms were exposed to a standard test exposure of 100 kVp/2.5 mAs. Scattered radiation was recorded and used as a measure of personnel exposure. When personnel exposure was considered, a figure of merit was calculated as an endpoint of optimization. The optimal kVp value for each phantom was determined based on the highest signal difference‐to‐noise ratio with or without inclusion of the figure of merit. When personnel exposure was not considered, increasing kVp resulted in higher signal difference‐to‐noise ratios and personnel exposure increased when both patient thickness and kVp increased. Findings indicated that a single standard technique of 100 kVp/2.5 mAs was only optimal for most medium‐sized patients. Images of thinner patients should be made with a lower kVp. Very large patients require a higher kVp than 100 regardless of the optimization method used. Personnel exposure from optimized techniques was low and not expected to exceed annual occupational dose limits.     

COMPARISON OF DIGITIZED AND DIRECT VIEWED (ANALOG) RADIOGRAPHIC IMAGES FOR DETECTION OF PULMONARY NODULES

The purpose of this study was to compare direct (analog) viewing of thoracic radiographs with digitized images obtained with a radiographic scanner and seven digital cameras for detection of pulmonary nodules. Direct viewing of the analog radiographs was significantly better than all digitized methods (P<0.01). Significant variations exist between the radiographic scanner and the digital cameras. The scanner (Kodak LS75) was significantly better than the Kodak DC 4800 and the Sony DSC-707 cameras (P<0.05). The Nikon 995, Canon EOS-D30, and Ricoh i500 were significantly better than the Sony DSC-707 (P<0.05). There was no significant difference between the Kodak DC 3800, Kodak DC 4800, and the Sony DSC-707. For pairwise comparison of raters (when evaluating the radiographs individually compared with the consensus), the raters matched the consensus rating from 85% to 92% with no significant difference between raters.     

RADIOGRAPH QUALITY EVALUATION FOR EXPOSURE VARIABLES—A REVIEW

Good quality radiographs are essential for making accurate diagnoses. Many factors influence the quality of radiographs including the x-ray machine specifications and settings, the darkroom environment and processing, and the choice of ancillary x-ray equipment (cassette properties, film/screen selection, use and properties of a grid). In compiling a technique chart, many of these variables are standardized so as to provide dependable guidelines for selecting the appropriate exposure settings (mAs and kVp) for a radiographic study. The systematic evaluation of image blackening, peripheral blackening, and the visibility of the gross image detail and contrast will facilitate the development of a technique chart as well as determining the source of the problem and necessary exposure setting changes for radiographs that are suboptimal. A flow diagram is described that will assist with the systematic evaluation of radiographic quality and provide guidelines for correcting exposure errors.     

COMPARISON OF FLAT-PANEL DIGITAL TO CONVENTIONAL FILM-SCREEN RADIOGRAPHY IN DETECTION OF EXPERIMENTALLY CREATED LESIONS OF THE EQUINE THIRD METACARPAL BONE

Radiographic diagnosis of equine bone disease using digital radiography is prevalent in veterinary practice. However, the diagnostic quality of digital vs. conventional radiography has not been compared systematically. We hypothesized that digital radiography would be superior to film-screen radiography for detection of subtle lesions of the equine third metacarpal bone. Twenty-four third metacarpal bones were collected from horses euthanized for reasons other than orthopedic disease. Bones were dissected free of soft tissue and computed tomography was performed to ensure that no osseous abnormalities were present. Subtle osseous lesions were produced in the dorsal cortex of the third metacarpal bones, and the bones were radiographed in a soft tissue phantom using indirect digital and conventional radiography at standard exposures. Digital radiographs were printed onto film. Three Diplomates of the American College of Veterinary Radiology evaluated the radiographs for the presence or absence of a lesion. Receiver operator characteristic curves were constructed, and the area under these curves were compared to assess the ability of the digital and film-screen radiographic systems to detect lesions. The area under the ROC curves for film-screen and digital radiography were 0.87 and 0.90, respectively ( P =0.59). We concluded that the digital radiographic system was comparable to the film-screen system for detection of subtle lesions of the equine third metacarpal bone.     

Transitioning to digital radiography

Objective – To describe the different forms of digital radiography (DR), image file formats, supporting equipment and services required for DR, storage of digital images, and teleradiology. Background – Purchasing a DR system is a major investment for a veterinary practice. Types of DR systems include computed radiography, charge coupled devices, and direct or indirect DR. Comparison of workflow for analog and DR is presented. Summary – On the surface, switching to DR involves the purchase of DR acquisition hardware. The X‐ray machine, table and grids used in analog radiography are the same for DR. Realistically, a considerable infrastructure supports the image acquisition hardware. This infrastructure includes monitors, computer workstations, a robust computer network and internet connection, a plan for storage and back up of images, and service contracts. Advantages of DR compared with analog radiography include improved image quality (when used properly), ease of use (more forgiving to the errors of radiographic technique), speed of making a complete study (important for critically ill patients), fewer repeat radiographs, less time looking for imaging studies, less physical storage space, and the ability to easily send images for consultation. Conclusions – With an understanding of the infrastructure requirements, capabilities and limitations of DR, an informed veterinary practice should be better able to make a sound decision about transitioning to DR.     

Assessment of low-cost teleradiology for grading elbow dysplasia.

Teleradiology involves the creation of a radiographic image that is then transmitted electronically. It has been shown that low-cost teleradiology has a high level of agreement when comparing the original radiograph to the digital image. However, there has been little investigation of the effect of digitization on the score allocated by a grading scheme. Radiographs of 60 canine elbows were selected, each in three projections (mediolateral flexed, mediolateral neutral, craniocaudal). Each radiograph was photographed at 3 megapixel (3 M) and 6 megapixel (6 M) resolution using a digital camera. The images were placed in groups (radiographs, 3 M and 6 M) and randomized. Each elbow was independently graded by a radiologist and an orthopedic surgeon using the BVA elbow scoring scheme, with the different image sets interpreted separately. Intra and interobserver agreement was compared using a kappa analysis. The radiologist had substantial intraobserver agreement for repeated grading of radiographs, and moderate agreement for the other intraobserver tests (3 M vs. radiographs, 6 M vs. radiographs, 3 vs. 6 M). The surgeon had moderate to substantial agreement for the intraobserver tests. There was reduced interobserver agreement for all image groups. These results suggest that low-cost teleradiology may only allow moderate accuracy when used for grading schemes, and this may affect its use for breed scoring schemes. However, there appears to be an inherent subjectivity present in the elbow-grading scheme, seen in both intra and interobserver analysis. Therefore, further study of teleradiology using a different scoring model (e.g., hip dysplasia) may be indicated.     

ACQUISITION HARDWARE FOR DIGITAL IMAGING

Use of digital radiography is growing rapidly in veterinary medicine. Two basic digital imaging systems are available, computed radiography (CR) and direct digital radiography (DDR). Computed radiographic detectors use a two‐step process for image capture and processing. Image capture is by X‐ray sensitive phosphors in the image plate. The image plate reader transforms the latent phosphor image to light photons that are converted to an analog electrical signal. An analog to digital converter is used to digitize the electrical signal before computer analysis. Direct digital detectors provide digital data by direct readout after image capture—a reader unnecessary. Types of DDR detectors are flat panel detectors and charge coupled device (CCD) detectors. Flat panel detectors are composed of layers of semiconductors for image capture with transistor and microscopic circuitry embedded in a pixel array. Direct converting flat panel detectors convert incident X‐rays directly into electrical charges. Indirect detectors convert X‐rays to visible light, then to electrical charges. All flat panel detectors send a digitized electrical signal to a computer using a direct link. Charge coupled device detectors have a small chip similar to those used in digital cameras. A scintillator first converts X‐rays to a light signal that is minified by an optical system before reaching the chip. The chip sends a digital signal directly to a computer. Both CR and DDR provide quality diagnostic images. CR is a mature technology while DDR is an emerging technology.     

ACQUISITION HARDWARE FOR DIGITAL IMAGING

Use of digital radiography is growing rapidly in veterinary medicine. Two basic digital imaging systems are available, computed radiography (CR) and direct digital radiography (DDR). Computed radiographic detectors use a two-step process for image capture and processing. Image capture is by X-ray sensitive phosphors in the image plate. The image plate reader transforms the latent phosphor image to light photons that are converted to an analog electrical signal. An analog to digital converter is used to digitize the electrical signal before computer analysis. Direct digital detectors provide digital data by direct readout after image capture—a reader unnecessary. Types of DDR detectors are flat panel detectors and charge coupled device (CCD) detectors. Flat panel detectors are composed of layers of semiconductors for image capture with transistor and microscopic circuitry embedded in a pixel array. Direct converting flat panel detectors convert incident X-rays directly into electrical charges. Indirect detectors convert X-rays to visible light, then to electrical charges. All flat panel detectors send a digitized electrical signal to a computer using a direct link. Charge coupled device detectors have a small chip similar to those used in digital cameras. A scintillator first converts X-rays to a light signal that is minified by an optical system before reaching the chip. The chip sends a digital signal directly to a computer. Both CR and DDR provide quality diagnostic images. CR is a mature technology while DDR is an emerging technology.     

Radiographic study of the maxillary canine tooth of four mesaticephalic cats

The radiopaque and radiolucent anatomical structures that are superimposed over the root of the maxillary canine tooth in mesaticephalic cats were identified on digital radiographs made at various angles. The vomer bone, the nasal bone, the palatine fissure, and the infraorbital foramen were not superimposed over the root of the canine tooth in the range of angles examined. Superimposition with the palatine sulcus (which is rarely visible clinically because of silhouetting of the soft tissues) only occurred at extreme horizontal (cross-sectional arc) angles. The second premolar tooth was superimposed at a cross-sectional angle of 80 degrees and 90 degrees. The structures of concern in the interpretation of radiographs of the maxillary canine tooth in mesaticephalic cats are the conchal crest, the line of conjunction between the vertical body of the maxilla and its palatine process, the incisivomaxillary canal (which is rarely visible on radiographic images), and the lachrymal canal. Because of their anatomical vicinity, the radiographic position of these structures relative to the maxillary canine tooth can only be minimally changed. It was not possible to identify an "ideal" angle to radiograph the maxillary canine tooth in these four mesaticephalic cats. However, an acceptable compromise between minimal distortion of the image and satisfactory visualization of the root was obtained with the radiographic beam (rostro-caudal rotation) angled at 80 degrees and the skull (rotation in cross-sectional arc) angled at 70 degrees.     

COMPARISON OF RADIOGRAPHIC AND COMPUTED TOMOGRAPHY LYMPHANGIOGRAPHY FOR IDENTIFICATION OF THE CANINE THORACIC DUCT

Standard radiographic lymphangiograms and computed tomography (CT) lymphangiograms were performed on 10 female dogs without intrathoracic disease. Positive contrast lymphagiography was performed by injection into a catheterized mesenteric lymphatic vessel, and lateral thoracic radiographs, ventrodorsal thoracic radiographs, and thoracic CTs were obtained. The number of visible ducts was recorded for each image at the midbody of the ninth thoracic vertebra (T9) through the first lumbar vertebra (L1). Data were combined for all dogs at each data acquisition point. Data were analyzed by comparing data from all three images independently, and then by combining data for the radiographs and comparing the study with the highest number of visible duct branches to the CT. Significant differences in numbers of branches were found at T11 and L1. This study suggests that CT may be able to quantify branches of the thoracic duct more accurately than standard radiographic lymphangiography.     

Comparison of computed radiography and conventional radiography in detection of small volume pneumoperitoneum

The role of digital imaging is increasing as these systems are becoming more affordable and accessible. Advantages of computed radiography compared with conventional film/screen combinations include improved contrast resolution and postprocessing capabilities. Computed radiography's spatial resolution is inferior to conventional radiography; however, this limitation is considered clinically insignificant. This study prospectively compared digital imaging and conventional radiography in detecting small volume pneumoperitoneum. Twenty cadaver dogs (15-30 kg) were injected with 0.25, 0.25, and 0.5 ml for 1 ml total of air intra-abdominally, and radiographed sequentially using computed and conventional radiographic technologies. Three radiologists independently evaluated the images, and receiver operating curve (ROC) analysis compared the two imaging modalities. There was no statistical difference between computed and conventional radiography in detecting free abdominal air, but overall computed radiography was relatively more sensitive based on ROC analysis. Computed radiographic images consistently and significantly demonstrated a minimal amount of 0.5 ml of free air based on ROC analysis. However, no minimal air amount was consistently or significantly detected with conventional film. Readers were more likely to detect free air on lateral computed images than the other projections, with no significant increased sensitivity between film/screen projections. Further studies are indicated to determine the differences or lack thereof between various digital imaging systems and conventional film/screen systems.     

99MTC-CIPROFLOXACIN IN IMAGING OF CLINICAL INFECTIONS IN CAMELIDS AND A GOAT

(99M)Tc-ciprofloxacin was used to image five adult camelids and a juvenile goat with clinical and/or radiographic signs of infection. (99m)Tc-ciprofloxacin (range 10-33 MBq/kg) was injected intravenously and a series of 2-min static images were acquired at 1- and 4-h postinjection. At 24-h postinjection, 5-min static images were acquired. Only the skull or abdomen was imaged in the adults; the whole body was imaged in the goat. The quality of the 1-, 4-, and 24-h studies was evaluated subjectively. Normal and abnormal areas of (99m)Tc-ciprofloxacin uptake were recorded and subjectively graded as mild, moderate or intense. Image quality was best 4-h postinjection. Twenty-four-hour images were poor because of insufficient radioactivity. (99m)Tc-ciprofloxacin imaging resulted in true positive or true negative scans in four of six animals. Two false-negative studies occurred. Intense (99m)Tc-cirofloxacin activity was seen in the lungs and urinary bladder, moderate/intense activity in the kidneys, and mild activity in the physes/epiphyses, liver and intermittently in the gastrointestinal tract. The normal distribution of (99m)Tc-ciprofloxacin in camelids/small ruminants differed from people. Further studies to determine the sensitivity and specificity of infection detection using (99m)Tc-ciprofloxacin in animals are warranted.