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Plain x-rays of the abdomen remain an integral feature of the diagnostic work-up in cases of acute abdomen. Chest x-rays, often recommended in the USA, are standard routine at only one third of Swedish radiology units. The article outlines the advantages of including chest x-ray in the abdominal examination: it facilitates the detection of pneumoperitoneum, it yields (pre-operative) cardiopulmonary information, and it may show abdominal pain to be of extra-abdominal aetiology. Regarding the latter point, a study of 555 cases showed the chest x-ray to yield valuable information in 14 cases.
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BACKGROUND: The routine chest radiography has been legally suppressed because of its low diagnostic profitability in non selected populations. Health surveillance of occupational populations at respiratory risk is entering a transitional period, where new guidelines are needed. Therefore, we determined to study the percentage of pathological findings in the chest radiographies of health examinations for hospital workers and whether it was possible to obtain explicative models allowing to calculate the probability of radiographies alteration. METHODS: A representative stratified sample of workers belonging to the Hospital La Paz in Madrid is studied, elaborating a transversal study based on the first health examination of their clinical history and two chest radiographies of further examinations. We carried out a multivariant analysis to calculate the probability of their alteration. RESULTS: We obtain alterations percentages of 19% for the first chest radiography; 23.5%, 22% and 21% for the two further ones and for the total, respectively. The explicative models obtained are based on age, family and personal antecedents of the respiratory disease, number of cigarettes smoked, cholesterol levels, the Mantoux test and the previous radiographies alteration. CONCLUSIONS: These equations may be an additional instrument together with labour environment considerations and within a clinical context, to help to the health specific occasional surveillance of the respiratory risk of hospital personnel.
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The major obstacle to optimal radiographic depiction of the chest has always been its anatomical features and, in particular, the considerable difference in X-ray beam attenuation between pulmonary and mediastinal structures. At least 40% of this region cannot be visualized in an optimal way. Therefore, much technological work was done to overcome this limitation, which has recently led to the development of electronic (Amber) and mechanical (homogenization) filtration systems. This study was aimed at assessing the capabilities of mechanical filtration, in terms of anatomical representation and lower biologic cost, the latter intended as lower exposure and absorbed doses. Therefore, eight radiologists studied 40 negative radiographs, i.e., a homogenized radiograph and a non-homogenized one per patient, twenty patients in all. The statistical analysis of the radiographs demonstrated the homogenized technique to allow better visualization of all the anatomical structures examined, i.e., trachea, carina, right and left main bronchi, aorta, spine and retrocardiac region. In contrast, the two radiographic techniques yielded much the same results in the depiction of the pulmonary pattern. As for dosimetry, good results were also obtained, because the homogenizer made it possible to reduce both exposure and absorbed doses to the lung and thyroid, while in the mediastinal region the absorbed dose remained similar to that measured with the non-homogenized even though exposure dose was increased mildly.
Bedside chest radiography accounts for an increasingly large portion of all chest X-ray examinations. Nevertheless, image quality is often poor mainly because of scattered radiations which decrease image contrast. Moreover, usually no grid is employed because of difficult beam alignment. This work was aimed at comparing different radiologic grids for bedside chest radiography. Fifty patients submitted to two bedside chest radiographs in 24 hours were studied. All the patients underwent the first exam with a Kodak InSight cassette with a newly-designed (columnar type) grid inside, while the second exam was performed with a conventional 8:1 focused lead-strip grid (Gilardoni) in 25 patients and with a 6:1 focused lead-strip grid (Gilardoni) in the extant 25 patients. Both grids were assembled in a Kodak InSight radiographic cassette. Three independent radiologists evaluated film quality, focusing on the depiction of some anatomical structures--e.g., the tracheobronchial tree, the retrocardiac lung, and devices. Seventy-five examinations were obtained for each grid and for each evaluated structure and graded as "good", "acceptable" and "poor". In the 6:1 vs columnar grid test, the highest rate of "good" and "acceptable"--i.e., diagnostic--findings was observed with the columnar grid in evaluating pulmonary vessels (71/75); the highest rate of "poor" findings was obtained with the same grid in evaluating tracheal bifurcation (43/75). In the 8:1 vs columnar grid test, the highest rate of diagnostic findings was shown by the conventional grid in evaluating retrocardiac lung parenchyma and by the columnar grid for pulmonary vessels (69/75); the highest rate of "poor" findings was obtained with the columnar grid in evaluating tracheal bifurcation (40/75). The statistical analysis of the results (Wilcoxon test) was made to compare the two conventional grids with the new columnar one. Statistically significant differences were observed between the 8:1 grid and the columnar grid to evaluate the bronchial tree. No differences were observed between the 8:1 grid and the columnar grid. Furthermore, to determine the effects of different degrees of grid decentering on image quality, a series of exposures was made using a lung-chest phantom. The grids, both the lead-stripe and the columnar one, were comparable. The higher-ratio grid proved better in evaluating tiny details. The columnar grid exhibited better tolerance to X-ray beam and to grid decentering.
We report a case of a 60-year-old patient with progressive soft tissue emphysema caused by infection with clostridium septicum. In contrast to a rather linear spread of air in non infectious soft tissue-emphysema, in this case a mainly vesicular spread of air in the soft tissue is noted on plain films. Together with the clinical history, this finding may indicate an infectious cause. The radiological interpretation is an important step in the diagnostical workup.
The homogenization of conventional chest radiographs is obtained with mechanical filtration of the X-ray beam and it allows opacity compensation of the different anatomical structures under examination; consequently, more pieces of diagnostic information on the mediastinum can be obtained. The authors used a mechanical device for equalization (Tau-Gil, Gilardoni SpA) with five different X-ray film/rare-earth screen combinations (3M Trimax) to investigate the following problems: a) choice of the best film-screen combination; b) results of the dosimetric comparison of filtered and non-filtered examinations; c) qualitative evaluation of equalization in terms of diagnostic information. One thousand analogic chest studies, 500 with and 500 without hard-filtering equalization, were performed with high-tension technique and statistically evaluated with a dedicated program. The authors concluded that: 1) the best qualitative results are obtained with GTU film/T6 screen combination, which seems to make the most satisfying compromise between sensitivity and spatial resolution and allows low X-ray exposure to be combined with good diagnostic results; 2) dosimetric tests clearly show that in hard-filtered studies the average incident dose to the patient is 12% lower than that given with no filter. Particularly, skin and lung doses decrease, while mediastinum dose doubles to allow the simultaneous visualization of mediastinum and parenchyma; 3) a substantial difference exists between the frequencies of excellent, good and bad results in the comparative series (with and without equalization) for the evaluation of central chest areas, especially for mediastinum, retrocardiac region and carena. The overall rate of poor results was reduced by equalization, ranging 11.6% to 2.8% (mean: 6.3%) in equalized studies, and topping 64.2% (average: 35.5%) in non-equalized studies. Therefore, in the authors' experience, equalization with this type of mechanical device improves the depiction of the mediastinal region, with no significant imaging loss in lung parenchyma demonstration. Moreover, hard-filtering decreases average incident dose to the chest and skin-lung dose, increasing mediastinum dose to allow its correct demonstration.
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