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.     

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 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.     

DIGITAL RADIOGRAPHY ARTIFACTS

Radiographic artifacts may mimic a clinical feature, impair image quality, or obscure abnormalities. With the development of digital radiography (DR), a new set of artifacts is introduced. Regardless of the technology, the classic technical errors that occur with film screen radiography still occur using DR. Artifacts created using computed radiography, DR, and incorrect image processing are discussed. Methods for correction of the artifacts are presented.     

Clinical Technique: Digital Radiography in Exotic Pets—Important Practical Differences Compared with Traditional Radiography

The future of radiography will be digital. In exotic pet radiography, where some of the animals have a very low body weight and anatomic structures can be small, detail rendition plays an important feature in image quality. Veterinarians should be familiar with the technical principles, image quality criteria, and radiation exposure issues associated with the various types of digital systems currently available. This article discusses basic principles of digital radiography, technical solutions, and selected parameters characterizing detectors, processing, and monitors. An overview of reported experiences is given, and results from experimental clinical studies are reviewed to evaluate the current options and limitations in applying digital radiography to exotic pet medicine.     

Microfocal radiography as an aid to the diagnosis of canine elbow osteochondrosis

One normal cadaver specimen and six labrador retrievers with suspected elbow osteochondrosis were examined using a microfocal radiographic technique as an aid to diagnosis. This allowed the production of a magnified image (macro-radiograph) with high spatial resolution. The macroradiographs were compared with radiographs obtained using a standard technique to see if they facilitated decision making with respect to case management. The lesions that were suspected from radiographic examination were correlated with the gross lesions found at elbow arthrotomy. Microfocal radiography gave additional information about the changes within the joints but it still remained difficult to image the lesion satisfactorily in some cases.     

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.     

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.     

Evaluation of Intra‐ and Interobserver Variability and Repeatability of Tibial Plateau Angle Measurements with Digital Radiography Using a Novel Digital Radiographic Program

Objective— To compare the intra‐ and interobserver variability occurring when observers with differing experience levels measure tibial plateau angles (TPAs) with a novel digital radiographic projection program (tibial plateau leveling osteotomy [TPLO] planning program), the Kodak Picture Archiving and Communications System (PACS), and standard sized printed films (SF). Study Design— Cross‐sectional study. Sample Population— Dogs (n=36) with cranial cruciate ligament (CCL) rupture that had a TPLO. Methods— Six observers, divided into 3 equal groups based on experience level, measured TPA on 36 digitally captured radiographic images of tibiae of dogs clinically affected with CCL rupture. Each observer used 3 methods of measuring TPA and repeated the measurements 3 times with each method. The intra‐ and interobserver variability was compared using the coefficient of variation. Results— Averaged over all replications and images, there was no significant difference (P>.05) in the average variability occurring with each method for all but 1 observer. There was no effect of experience level on measurement variability; however, interobserver variability was significantly less with measurements made with the PACS and TPLO planning program compared with measurements made from SF (P<.05). Conclusions— Repeated measurements of TPA made using digital images and computer‐based measurement programs were significantly less variable between observers than those made from images printed on standard radiographic films. Clinical Relevance— Digital radiography and computer‐based measurement programs are effective for determining the TPA, allowing less variability in measurements compared with SF. The ability to manipulate the image may allow better identification of anatomic landmarks.     

EVALUATION OF THE EQUINE DIGITAL FLEXOR TENDON SHEATH USING DIAGNOSTIC ULTRASOUND AND CONTRAST RADIOGRAPHY

This study was designed to evaluate the normal anatomy of the digital flexor tendon sheath using contrast radiography and diagnostic ultrasound. Iodinated contrast medium was injected into eight cadaver limbs and the limbs immediately frozen. Lateromedial and dorsopalmar/plantar radiographs were made. These limps were then cut transversely and proximal to distal radiographs of each slab were made. This cross sectional contrast methodology allowed the visualization of the relative size and shape of the superficial and deep digital flexor tendons as well as the potential space taken by effusions of the digital flexor tendon sheath.
The second part of the study used twelve live animals with normal digital flexor tendon sheaths. Ultrasonographic measurement of the structures of the digital flexor tendon sheath at each level were compiled. This documented the ability of diagnostic ultrasound to image: 1) the superficial and deep digital flexor tendons, 2) the proximal and distal ring of the manica flexoria , 3) the straight and oblique sesamoidean ligaments, and 4) the mesotendinous attachments to the superficial and deep flexor tendons. Iodinated contrast medium was then injected into the digital flexor tendon sheath and the ultrasonography repeated. These images were compared with those obtained from contrast radiography and prosections of twenty normal limbs. The iodinated contrast medium enhanced sonographic imaging of the structures of the digital tendon sheath, particularly the abaxial borders of the superficial digital flexor tendon branches and the mesotendinous attachments to the superficial and deep digital flexor tendons.     

Common artefacts and pitfalls in equine computed and digital radiography and how to avoid them

Radiographic technology has rapidly advanced over the last decade with the use of both computed radiography and digital radiography now being common in equine practice. Image quality is critical for optimal diagnostic accuracy, so identification of factors that negatively influence quality is vital. The most commonly encountered problems include positioning errors, exposure anomalies, movement artefacts, labelling errors and image processing faults. The aim of this review is to describe common radiographic faults that will allow the equine practitioner to recognise and learn how to prevent these issues, thus improving image quality. This will aid in improving diagnostic accuracy and will enhance radiation safety by reducing the number of repeat exposures required.     

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.     

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.     

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.     

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.     

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.     

MAGNETIC RESONANCE IMAGING OF THE EQUINE DIGIT WITH CHRONIC LAMINITIS

Chronic laminitis is a severe disease affecting the equine digit. It was hypothesized that magnetic resonance (MR) imaging would improve visualization of structures within the foot and pathology associated with chronic laminitis. This study aimed to describe the MR imaging findings in chronic laminitis, compare different pulse sequences for visualization of pathology, and to compare MR imaging with standard radiography. Twenty (10 forelimb, 10 hindlimb) cadaver limbs from 10 horses clinically diagnosed with chronic laminitis (group L) and 10 limbs without laminitis (group N) were used. Lateromedial radiographs and sagittal and transverse MR images of the foot were obtained. Radiographs and MR images were evaluated for anatomic definition and evidence of pathology. Dorsal hoof wall thickness and angle of rotation and displacement distance of the distal phalanx were measured. Comparisons were made between group L and N, forelimb and hindlimb within each horse, and MR imaging and radiography. Features consistently noted with MR images in group L, but not detected using radiography, included laminar disruption, circumscribed areas of laminar gas, laminar fluid, and bone medullary fluid. Other findings seen only on MR images included increased size and number of vascular channels, alterations in the corium coronae, and distal interphalangeal joint distension. Magnetic resonance imaging allowed better definition of laminar gas lines and P3 surface irregularity observed on radiographs. Based on measurements, group L had a greater angle of rotation, distal displacement, and dorsal hoof wall thickness than group N; forelimb hoof wall thickness was greater than hindlimb; and distal displacement and hoof wall thickness measurements were smaller using MR imaging than radiography, but had a similar pattern. It is concluded that there are features of chronic laminitis consistently observed using MR imaging and that these may be additional to features observed radiographically.     

Investigation of Ossification Pattern of Structures of Equine Metacarpophalangeal Articulation with the Aid of Digital Imaging Segmentation and Processing Techniques: A Preliminary Report

Radiographs, taken at lateromedial (LM) view, were obtained from metacarpophalangeal articulations of 25 horses of variable ages, ranging from 2 to 20 years, as well as a few of undetermined ages. Images of radiographs were acquired as digitized images with the aid of high-resolution (megapixel) digital cameras directly from lighted platforms, and the acquired 24-bits bitmap formatted images were converted to 8-bit grayscale tagged-image format (TIF) images. The TIF images were processed by a technique involving an on-screen quantitative evaluation of spot pixel intensity values in the digitized images, followed by monadic arithmetic pixel subtraction and addition. A color mapping of the pixels into their respective red and blue sub-spectra of the RGB spectrum also was performed. The entire processing operation was accomplished through the use of a standard digital imaging software. The results demonstrate typical bands of possible ossification pattern within the diaphyses, metaphyses, and the epiphyses of the articulating metacarpal and proximal phalanx in the processed radiographic images compared with their nonprocessed counterparts. The relevance of this novel observation, although preliminary, lies in the prospects of assessing pre-race skeletal health status of horses through a cost-effective, simple, and reliable method.     

Assessment of on-screen measurements, magnification, and calibration in digital radiography

Objective-To compare calibration methods for digital radiography in terms of measurement accuracy and interobserver variability. Design-Prospective study. Sample-Digital radiographic images of a 155-mm-long Steinmann pin. Procedures-Measurement of pin length on digital radiographs was determined with a 25.4-mm-diameter calibration ball and commercially available software program via 3 calibration methods (ie, no calibration, autocalibration, and manual calibration). Digital radiographs of the calibration ball and pin were obtained with each placed at various vertical heights from the table (7 heights) and horizontal distances from the center of the beam (4 distances). Measurements of pin length on digital radiographs were made by 4 observers who were blinded to the orientation of the calibration ball and pin. Results-Pin lengths obtained by each calibration method were significantly different from each other and from the true value. Manual calibration was the most accurate. There was no significant interobserver variability in measurements. There was no significant change in measurements when the calibration ball was moved horizontally, but pin length measurements changed significantly when the ball was moved vertically (away from the table) with an approximate magnification error of 1% per centimeter of distance between the calibration ball and pin. Conclusions and Clinical Relevance-For digital radiography, manual calibration is recommended to achieve the most accurate measurements. Ideally, the calibration ball should be placed at the same vertical height as the object to be measured; however, if this cannot be achieved, the magnification error can be expected to be approximately 1% per centimeter of distance.