COMPARATIVE EVALUATION OF AN ULTRAVIOLET AND AN ORTHOCHROMATIC RARE-EARTH IMAGING SYSTEM FOR VETERINARY RADIOGRAPHY

The relative quality and speed of a new ultraviolet-emitting screen, ultraviolet-sensitive film rare-earth system (DuPont Ultra-Vision®) was compared to an orthochromatic rare-earth system (Kodak Lanex®) in a clinical trial. Seven different sets of radiographs of a human foot phantom, or actual canine anatomical structures (tarsus, pelvis, skull, chest, abdomen) were evaluated independently by radiologists, radiology residents and technicians who were unaware of the screen/film combinations used. The 400-speed, Ultra-Vision® Rapid/UVG screen/film combination produced supervisor image detail compared to blue/green emitting 400 and 200-speed screen/film combinations. The image detail of the Ultra-Vision® Rapid/UVG system was nearly equivalent to that produced using a 100-speed, fine-detail blue/green emitting screen/film combination. A 200-speed Ultra-Vision® system was also tested and produced thoracic and abdominal radiographs of equivalent to slightly supervisor quality than those produced using blue/green emitting system.     

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.     

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.     

RARE EARTH INTENSIFYING SCREENS FOR VETERINARY RADIOGRAPHY: AN EVALUATION OF TWO SYSTEMS

Two rare earth radiographic intensifying screen-film systems were compared with a calcium tungstate screen-film systems in a series of clinically oriented trials. The calcium tungstate screen-film system was subjectively judged to have the highest overall image quality, primarily because of its wide latitude. Several rare earth screen-film combinations produced radiographs of excellent diagnostic quality. In general, image quality was inversely related to screen-film speed, whereas radiation protection was directly related to screen-film speed. Medium-speed rare earth screen-film combinations resulted in reductios of scatter radiation on the order of 30 to 70 percent compared with the par-speed film combination. Recommendations are made regarding the use of specific rare earth intensifying screen-film combinations in small and large animal diagnostic radiography.     

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.     

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 TRANSPLENIC MULTIDETECTOR CT PORTOGRAPHY TO MULTIDETECTOR CT-ANGIOGRAPHY IN NORMAL DOGS

We evaluated transplenic injection of iodinated contrast medium for computed tomography (CT) assessment of the portal vasculature. Specific aims were to: (1) establish a protocol for transplenic transplenic CT portography using a 40-row multidetector scanner; (2) compare transplenic CT portography to dual-phase CT angiography in terms of image quality, opacification of the portal system, and contrast enhancement of the portal vasculature and liver; (3) compare personnel exposure during transplenic CT portography and transplenic portal scintigraphy. Seven juvenile dogs underwent transplenic portal scintigraphy, CT angiography, and transplenic CT portography. Transplenic portal scintigraphy and CT angiography were performed using previously established protocols. For transplenic CT portography, a 20- or 22 gauge needle attached to an extension set was placed into the splenic parenchyma using CT guidance. Iodinated contrast medium (175 mg I/ml) was administered, and CT acquisition was started at the time of the injection. Transplenic CT portography was simple, rapid and provided more intense enhancement of the splenic and portal veins, with a lower contrast medium dose (median dose: 525 mg I for transplenic CT portography, 7700 mg I for CT angiography), but caused inconsistent intrahepatic portal branches and parenchymal opacification due to streamlining and streak artifacts. Despite significantly lower attenuation values in the portal vein, CT angiography provided sufficient enhancement for vessel identification and more consistent parenchymal hepatic enhancement. Personnel radiation exposure rate was higher during transplenic CT portography (0.0725 mSv/min) compared with transplenic portal scintigraphy (0.000125 mSv/min). As transplenic CT portography requires an average injection time of 1 min per study; over 650 [corrected] studies must be performed before reaching the maximum permissible whole body dose of 0.05 [corrected] Sv.     

USE OF PORTAL RADIOGRAPHY TO INCREASE ACCURACY OF DOSE DELIVERY IN RADIATION THERAPY

Port films were acquired for all radiation therapy patients (n = 132) treated over a thirteen month period to 1] assist in initial treatment field set-up on Day 1, 2] for quality assurance with a second port film taken on Day 7 of radiation therapy, and 3] as a means to document the radiation treatment field as a part of the patients permanent medical record. Port films were used for both patients treated with a definitive course of radiation (n = 97 patients), and those treated palliatively (n = 35 patients). The portal radiographs were valuable in terms of the initial set-up, and to correct for any positioning or other errors at the time of the one week recheck. Changes were made, based on the initial port film on Day 1, in 53% and 57% of treatment fields for palliative and definitive radiation patients, respectively. The changes made in both definitively and palliatively irradiated patients were usually in field position, an increase in field size to include all of the tumor, or a decrease in field size to spare normal tissue. Fewer changes were necessary based on the Day 7 recheck port films, but these day-7 rechecks are recommended for quality control. Based on the high frequency of changes introduced because of the initial port film findings, it is recommended that port films be incorporated on a routine basis in veterinary radiation therapy.     

SUBTRACTION PORTAL VENOGRAPHY

Photographic subtraction was made of 38 canine portal venograms to remove the images of the overlying abdominal structures and enhance the radiographic contrast of portal veins. The improved visual quality of the subtracted portogram aided in the detection of portosystemic shunts and intrahepatic portal veins. The subtraction studies revealed portosystemic shunts not detected on the initial portal venogram.     

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.     

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.     

A COMPARISON OF RADIOGRAPHIC AND COMPUTED TOMOGRAPHIC FINDINGS IN 31 DOGS WITH MALIGNANT NASAL CAVITY TUMORS

Nasal cavity radiographs and CT images from 31 dogs with nasal cavity cancer were compared. All dogs had abnormal clinical signs relating to -nasal cancer and histologic confirmation of malignant nasal cavity neoplasia. No dog had cyto reductive surgery prior to imaging. All radiographic and CT examinations were abnormal. CT was more accurate than radiographs in identifying unilateral versus bilateral nasal cavity disease and tumor extension into adjacent structures such as the cranial cavity, hard palate, and pterygopala-tine fossa. The improved accuracy of CT in these respects was not of benefit in the confirmation of nasal cavity disease because radiographs were abnormal in every instance. However, CT may be useful for more accurate tumor staging, predicting possible treatment-related complications, and planning of surgery and radiation therapy. It was also determined that one dorsally located radiation therapy portal bounded laterally by the medial ocular canthi, as described in previous reports, would not have been adequate for encompassing all abnormal tissue in 28 of the 31 dogs evaluated.     

THREE-DIMENSIONAL HELICAL COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF THE LIVER IN FIVE DOGS

The objective of this study was to develop a simple, safe, minimally invasive protocol to evaluate the hepatic vasculature. Five purpose-bred Beagle dogs underwent noncontrast-enhanced computed tomographic scan of the entire abdomen. A dynamic, nonincremental computed tomography scan at the level of T11 was then performed using a test bolus of contrast medium to determine time to peak opacification and to aid in the calculation of scan delay. The time to peak arterial enhancement ranged from 2.0 to 7.0 s, with a median of 2.0 s. The time to peak portal venous enhancement ranged from 23.0 to 46.0 s, with a median of 32.0 s. Scan delay for arterial opacification ranged from 0 to 5.0 s, with a median of 0 s. Scan delay for the portal phase of opacification ranged from 6.0 to 21.0 s, with a median of 17.0 s. Using this information, two separate computed tomographic studies were used to image the arterial and portal venous phases of circulatory opacification, respectively. The dogs were hyperventilated to prevent breathing motion during the scan, each of which required approximately 20 s. A power injector was used to inject diatrizoate meglumine (128 mg I/kg) through an 18-gauge cephalic vein catheter at a rate of 5 ml/s. Scanning was initiated after the appropriate scan delay to optimize the specific phase of vascular filling. Maximum intensity projections allowed clear delineation of the hepatic arteries and the portal venous system, while eliminating overlying structures that might interfere with image analysis. Time/density curves were generated, and the time needed for each study was recorded. Hepatic arteries and portal veins were clearly visualized in all dogs. Parenchymal opacification was also observed.     

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.     

RADIOGRAPHY OF THE EQUINE STOMACH

To obtain radiographic information concerning the equine stomach, a gastrographic contrast examination is required. This study describes this procedure in detail. A powerful radiographic unit, the tubehead linked to an image intensifier and suspended by an electromechanical overhead gantry system, is required. To obtain accurately positioned radiographs during the fluoroscopic examination, a cassette holder with a stationary grid is mounted at the entrance window of the image intensifier. The examination is performed in the unsedated standing horse after 24 hours of starvation, using a combination of survey radiography and fluoroscopic viewing after the inflation of air, followed by the administration of barium sulphate suspension by stomach tube. The gastrographic contrast examination is performed in three experimental animals and 23 abnormal horses. Pneumogastrophy appeared to be valuable to diagnose gastric tumors, to differentiate between gastric tumors and other masses in the cranial abdomen, and to visualize gastric parasites, even in large horses. The use of barium sulphate suspension does not result in an adequate double contrast of the stomach, but it may aid to diagnose esophagogastric or pyloric stenosis and gastric or duodenal ulcers.     

Comparative evaluation of six different body regions of the dog using analog and digital radiography

In this study the quality of digital and analog radiography in dogs was compared. For this purpose, three conventional radiographs (varying in exposure) and three digital radiographs (varying in MUSI-contrast [MUSI = MUlti Scale Image Contrast], the main post-processing parameter) of six different body regions of the dog were evaluated (thorax, abdomen, skull, femur, hip joints, elbow). The quality of the radiographs was evaluated by eight veterinary specialists familiar with radiographic images using a questionnaire based on details of each body region significant in obtaining a radiographic diagnosis. In the first part of the study the overall quality of the radiographs was evaluated. Within one region, 89.5% (43/48) chose a digital radiograph as the best image. Divided into analog and digital groups, the digital image with the highest MUSI-contrast was most often considered the best, while the analog image considered the best varied between the one with the medium and the one with the longest exposure time. In the second part of the study, each image was rated for the visibility of specific, diagnostically important details. After summarisation of the scores for each criterion, divided into analog and digital imaging, the digital images were rated considerably superior to conventional images. The results of image comparison revealed that digital radiographs showed better image detail than radiographs taken with the analog technique in all six areas of the body.     

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.     

ANATOMY OF THE PORTAL AND HEPATIC VEINS OF THE DOG: A BASIS FOR SYSTEMATIC EVALUATION OF THE LIVER BY ULTRASONOGRAPHY

The objective of this study was to define, in detail, the anatomy of the portal and hepatic veins in the dog in order to establish a procedure for the systematic evaluation of the liver by ultrasonography. Anatomical details were obtained from the formalin fixed livers of ten dogs. The hepatic and portal veins were removed intact from these livers so that a detailed pattern of distribution could be established and the numbers of branches could be counted. Silastic casts were also made of the hepatic and portal veins of two livers, one in situ and one in which it had been removed. The former was to enable the relationship of the portal to the hepatic veins to be established as closely as possible within the animal and the other to provide a model of the distribution of each venous system within the liver. Contrast medium was infused into two other livers and radiographs taken to establish the relationship of each branch to each lobe. It was found that there was a consistent pattern of venous branching to each lobe of the liver in the dog with little variation between individual specimens. All liver lobes contained definite venous branches so that the left lateral and medial, quadrate, right medial and lateral, caudate and papillary veins could be distinguished in each venous system. We believe that an appreciation of this venous distribution will aid in the systematic evaluation of the liver during ultrasonography by enabling identification of each liver lobe. It should be of value for differentiating portal from hepatic veins and veins from dilated bile ducts.     

EFFECTS OF FASTING AND INTRALUMINAL CONTRAST ENHANCEMENT ON ULTRASONOGRAPHIC APPEARANCE OF THE EQUINE SMALL INTESTINE

The equine small intestine is challenging to evaluate ultrasonographically. In humans, hydrosonography has been used to improve ultrasonographic images of the small intestine. We hypothesized that fasting horses for 24 h would enhance the ability to image the small intestine transabdominally by separating intestinal loops and reducing intraluminal gas, and that the administration of intragastric contrast agent would further improve that ability. Ten healthy horses were examined ultrasonographically under three treatment conditions: (a) regular diet, (b) after a 24‐h fast, and (c) fasted plus intragastric administration of water and mineral oil. During each phase of the study, 30‐s video clips were obtained from four predetermined abdominal windows, and were examined to determine diagnostic quality. Fasting improved the ability to obtain high‐quality images of the small intestine significantly. The addition of contrast agent resulted in qualitative improvement in image quality, but differences did not result in statistically significant improvement.     

Rare earth intensifying screens in veterinary radiology

Radiation dose to personnel and low capacity X–ray equipment are obstacles to the optimal use of veterinary radiology. In order to find means to lower radiation dose and improve the quality of the radiographic image in veterinary radiology the authors have tested the so–called rare earth intensifying screens under experimental and clinical conditions. Of the basis of their findings they recommend the use of predominantly green light–emitting screen with lanthanum oxysulphide crystals activated with terbium, in combination with orthochromatic film. This combination was shown to give the best ratio image–screen noise. Considerable dose reduction was obtained with this system, and the image quality improved due to less blurring by motion.