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Biomedical subjects

J M Bramble

Publications and source records attributed to J M Bramble.

17 recordsLinked to original sources

Computed radiography in musculoskeletal imaging: state of the art.

Computed radiography is a 2K x 2K x 10 bit digital radiographic system that replaces the film-screen combination with a photo-stimulable phosphor plate. The advantages of this relatively new technology include linear detector response, improved detector efficiency, and digital processing capabilities. Musculoskeletal applications benefit significantly from these attributes, which result clinically in the ability to reduce both radiation dose and number of exposures. Studies of observers' performance have shown no statistically significant difference in diagnostic accuracy between film-screen and computed radiographic musculoskeletal images. Computed radiography is particularly useful in the evaluation of the musculoskeletal system in traumatized patients with portable radiographs, spine radiographs, scoliosis studies, and depiction of soft-tissue abnormalities. Limitations include change in image format and size, high cost, decreased spatial resolution, restricted throughput, increased perception of noise, and new artifacts that must be recognized. Spatial resolution limitations of computed radiography in identification of fine detail information can be improved by using magnification techniques. Radiation dose reduction with an exposure decrease of 25-50% can be achieved without loss of diagnostic accuracy, although this depends on the examination and the abnormality. An interactive workstation is important in the use of a computed radiographic system with capabilities to adjust display parameters to best depict images and disease. We conclude that computed radiography is an alternative to film-screen radiography without significant differences in diagnostic quality in the evaluation of musculoskeletal images.

Humans

Clinical experience in the use of photostimulable phosphor radiographic systems.

The experience with CR systems gained at the three institutions described in this report demonstrates numerous advantages over the conventional screen-film system. These include: (1) a reduction in the radiation exposure delivered to the patient (25% to 50%); (2) a decrease in the number of repeat examinations needed, especially in portable units where technical difficulties are common with screen-film examinations; this is attributable to the linear, wider dynamic range of CR systems compared with screen-film combinations; (3) the capability to archive electronically all images by means of a digital optical storage system; (4) automatic electronic setting of the laser scanner for the latitude and sensitivity on each image; (5) the digital images are available for transmission to all image display workstations on a local or wide-area network; and (6) the ability to adjust interactively the display parameters to best depict images and pathology as well as salvage technically suboptimal examinations. Several disadvantages of CR systems compared with conventional screen-film examinations have also been identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans

Sacroiliitis: MR imaging findings.

Magnetic resonance (MR) imaging was performed in seven asymptomatic volunteers and 17 patients with clinical and radiologic evidence of sacroiliitis. MR imaging findings were compared with those at computed tomography (CT) to determine the MR imaging appearance of the sacroiliac joint when normal and in sacroiliitis. The normal articulation was well depicted with MR imaging. Findings of sacroiliitis were identified in 20 sacroiliac joints (12 patients). MR imaging findings characteristic of sacroiliitis included abnormal cartilage signal intensity (95% of joints) and erosions (75% of joints) on T1-weighted images. Areas of increased intensity in the articulation (80% of joints) or in erosions (60% of joints) were seen on T2-weighted images. MR imaging was superior to CT for evaluation of cartilage and detection of erosions. Four sacroiliac joints (20%) and two patients (17%) with MR imaging findings of sacroiliitis were negative at CT. The authors conclude that MR imaging is a valuable method for detecting sacroiliitis, particularly when results of other imaging techniques are inconclusive.

Adolescent

Information retrieval for teaching files: a preliminary study.

A computer algorithm for information retrieval from an electronic teaching file has been developed. This index enables the user to retrieve cases from a teaching file, based on the input of a combination of features. The algorithm is based on nearest neighbor analysis, and is programmed in the "C" language. A teaching file with this index is very easy to use as a reference resource for diagnosing unknown cases. A model was developed for a preliminary test of how likely a user would be to review a teaching file case that is the same diagnosis as an unknown case, thereby reducing uncertainty of diagnosis. The model used 110 cases of arthritis radiographs of hands scored by a skeletal radiologist. The result of the model suggests that the correct diagnosis would be reviewed 83% of the time. A standard method of reducing uncertainty of diagnosis (the maximum likelihood discriminant function) would have picked the correct diagnosis 78% of the time. The results indicate that a teaching file with the computer index is a practical tool for dealing with the uncertainty in diagnosis of unknown cases. The computer index could be included with videodisc-based teaching files (such as the American College of Radiology files). Using teaching files as a reference for interpreting unknown cases may reduce interobserver variability.

Algorithms

Experience in the use of an image-processing workstation for a photostimulable phosphor radiographic system.

Photostimulable phosphor radiographic (computed radiographic) systems are being installed and evaluated by radiology departments. The use of interactive image-processing workstations are a major advantage for any computed radiography system. An interactive image-processing workstation enables rapid image retrieval, reduces the examination repeat rate, provides for image enhancement, and rapidly sets the desired display parameters for laser-printed images. The authors have conducted over 2,500 radiographic examinations using a computed radiographic system equipped with an interactive image-processing workstation. Their experience supports the necessity of such a workstation.

Computer Systems

Perimeter encoding for teleradiology.

Perimeter encoding is a technique of data compression that is done simply by outlining the area of interest on an examination. In a sample of 92 emergency room examinations (excluding chest, abdomen, and pelvic exams), 304 films were interpreted by a resident radiologist who indicated the area of interest by marking four corners of a rectangle. The adequacy of the area of interest was determined by a staff osteoradiologist during subsequent review of the films. The amount of data reduction was measured by determining the ratio of the area of interest inside a rectangle to the area of the film (compression ratio). The overall average compression ratio was 3 to 1. This preliminary study suggests that further evaluation of perimeter encoding is warranted.

Emergency Medical Service Communication Systems

Nondisplaced fractures: spatial resolution requirements for detection with digital skeletal imaging.

Fifty-six radiographs of nondisplaced or minimally displaced fractures of the extremities and an equal number of studies with normal findings were selected and digitized to produce spatial resolution varying from 5.75 to 0.72 line pairs per millimeter (1p/mm), corresponding to pixel sizes ranging from 0.08 to 0.64 mm. The conventional and digitized images were evaluated by 10 radiologists, who gave their decision confidence on a graded scale. Receiver operating characteristic analyses were performed from these data to compare the digital images with the conventional radiographs. There was a progressive improvement in observer performance as the pixel size decreased. A pixel size greater than 0.16 mm (2.88 1p/mm) resulted in a significant loss of diagnostic accuracy in comparison with conventional radiographs. Specific fractures in which a larger pixel size adversely affected the evaluation included torus injuries, corner fractures in child abuse, minimal avulsion injuries, and fractures that demonstrated only trabecular disruption.

Adult

Image data compression in magnification hand radiographs.

A study was conducted on the use of an irreversible compression technique, Fourier quantization, to reduce the amount of digital data needed for an image. The effect of image compression was studied in radiographs obtained to diagnose subperiosteal bone resorption. Magnification radiographs of 44 hands were digitized to an array size of 4,096 X 4,096 X 12 bits. Selected subregions containing a single middle phalanx were compressed and reconstructed. A subset of the resultant 12-bit uncompressed and 8-, 7-, and 6-bit compressed images were read by four radiologists whose responses were analyzed with receiver operating characteristic (ROC) techniques. There were 81 images used in the ROC analysis, of which 48 were normal and 33 showed subperiosteal resorption. No statistically significant loss of diagnostic quality was detected for 8- or 7-bit compressed images, with average compression ratios of 16:1 and 28:1, respectively. Diagnostic quality was lost with 6-bit images, with an average compression ratio of 107:1.

Arthritis

Comparison of information-preserving and information-losing data-compression algorithms for CT images.

Data compression increases the number of images that can be stored on magnetic disks or tape and reduces the time required for transmission of images between stations. Two algorithms for data compression are compared in application to computed tomographic (CT) images. The first, an information-preserving algorithm combining differential and Huffman encoding, allows reconstruction of the original image. A second algorithm alters the image in a clinically acceptable manner. This second algorithm combines two processes: the suppression of data outside of the head or body and the combination of differential and Huffman encoding. Because the final image is not an exact copy, the second algorithm is information losing. Application of the information-preserving algorithm can double or triple the number of CT images that can be stored on hard disk or magnetic tape. This algorithm may also double or triple the speed with which images may be transmitted. The information-losing algorithm can increase storage or transmission speed by a factor of five. The computation time on this system is excessive, but dedicated hardware is available to allow efficient implementation.

Algorithms

A report-coding system for integration into a digital radiology department.

Report-coding systems allow the radiologist to generate a typewritten radiographic report with a computer. Typically, the report is generated by selecting bar codes, speaking key words, or selecting items on a screen. MAMM REPORT is a report-coding system for mammography, developed by radiologists, that runs on a microcomputer (Amiga, Commodore Co., West Chester, PA). MAMM REPORT speaks questions to the radiologist, who responds by pressing one of two buttons on a computer mouse, thus generating the report. MAMM REPORT allows labeling of digital images and reduction of data required to store the report in computer memory (data compression). Data compression is useful for improving computer operating speed. Digital image labeling and data compression facilitate use of MAMM REPORT on a future digital radiology workstation for an all-digital radiology department. Sixty mammographic reports, reviewed by a radiologist who is not a specialist in mammography, were entered into MAMM REPORT. The mammography specialists who dictated the original reports then judged whether the reports generated by MAMM REPORT would be acceptable replacements on the basis of descriptions of findings, diagnoses, and recommendations for further study. Data compression was measured by calculating the ratio of the number of bytes for storage of the reports in original form to a standard storage form (Huffman encoding) and to the MAMM REPORT coded form. All 60 coded reports were acceptable replacements for the original reports. For computer storage, MAMM REPORT produced a compression ratio of 135 to 1 and Huffman encoding, 1.1 to 1. Huffman encoding did not compress most reports because of their brevity. The results indicate that report coding can produce data compression of radiographic reports. The standard method of text storage, Huffman encoding, is not suitable for application to mammographic reports, which tend to be brief.

Electronic Data Processing

Diagnostic imaging of spinal trauma.

The radiologist has a pivotal role in evaluation of spinal trauma patients because proper treatment cannot begin before the abnormality is diagnosed. Plain films remain the screening modality of choice, and by understanding the radiographic signs of injury, patterns produced by various traumatic mechanisms can be recognized. As radiologists we can then provide insight to our clinical colleagues into the optimal methods of further investigation. The objective is to eliminate the possibility of further damage and to identify lesions amenable to correction.

Fractures, Bone

A modified color display for computed tomography.

An algorithm for color assignment of computed tomography (CT) scans is presented. The intention is to produce color images similar to illustrations in anatomy atlases. There are three major advantages to the use of this color assignment algorithm. A single color image may replace the multiple monochrome density range pictures now used for portraying CT information. Perception of low spatial frequencies is improved, which may improve detection of soft tissue tumors. Finally, there are economic advantages for using color displays and printed color copies.

Algorithms