床边CR摄影与传统床边摄影的对比研究

目的：评价计算机X线摄影术(CR)在床边照片的应用。方法：抽取我院CR床边按照影像和传统床过照片备1000例，由2位放射学医师及1位主管技师对影像进行分析，分别统计甲、乙、丙及废片率，同时也对条件进行分析评价。结果：(1)CR影像：甲级片率32．1％，乙级片率44.5％，丙级片率23．4％，废片率0％。(2)传统床造影像：甲级片率20．3％，乙级片率53．5％，丙片率16．8％，废片率9．4％。结论：CR床边照片质量明显比传统床边投照优秀，CR床边照片有利于放射诊断。     

如何质控CR片影像质量的探讨

目的：探讨CR片甲片率评片标准，进一步提高CR影像质量。方法：随机抽取X线普通片1000张：质控前CR片1000幅（工作站）；质控后CR片1000幅（工作站）。参照1996年创等级医院时甲片率的标准进行质控。结果：X线普通片的甲片率为42．5％；质控前CR片甲片率为56％；质控后CR片的甲片率为88．5％。结论：总结如何质控CR片影像质量几点建议，仅供参考。     

CR摄影与屏-片摄影的比较

目的探讨CR摄影与屏-片系统摄影曝光条件及对患者的X射线辐射剂量，评价CR摄影的应用价值。方法取本院CR照片和常规X射线摄影照片各2500份，由2位主管技师和1位副主任技师对照片按部位分组进行分析，统计出甲、乙、丙及废片率；并对乙、丙及废片产生的原因进行分析。结果①照片质量：CR摄影照片甲级片率63．6％，乙级片率27．2％，丙级片率9．2％，废片率0％；屏-片系统摄影照片甲级片率40．2％，乙级片率42．4％，丙级片率15．6％，废片率1．8％。②摄影条件的比较：CR数字摄影比屏．片系统摄影电压需提高1-6kV，曝光量高20％左右。结论CR数字摄影照片质量明显高于屏-片系统摄影，但曝光条件比屏-片系统高，相对增加了患者的X射线辐射剂量。     

计算机X线摄影与屏片系统摄影对比分析

目的:评价计算机X线摄影(CR)的应用价值。方法:抽取我院CR照片和常规X线摄影照片各1200 例,由2位主管技师和1位副主任技师对照片进行分析,统计出甲、乙、丙及废片率。并对乙、丙级片及废片产生的 原因进行了分析。结果:①照片影像质量:CR照片甲级片率51.6%,乙级片率35.5%,丙级片率12.2%,废片率 0.7%。常规X线摄影照片甲级片率40.6%,乙级片率42.5%,丙级片率15.2%,废片率1.7%。②摄影条件:数字 比模拟摄影电压高1～5kV,曝光量高20%左右。结论:CR摄影影像质量好于模拟摄影(即甲级片率高,废片率 小),可为临床提供可靠诊断。但曝光条件比屏 片系统高,增加了病人的X线接受剂量。     

CR系统在乳腺摄影中的应用分析

目的:评价CR系统在乳腺摄影中的应用价值。方法:抽取我院CR乳腺照片和传统钼靶X线照片各800张进行分析,统计出甲、乙、丙级片及废片率;统计CR片及传统屏-片乳腺癌的诊断正确率。结果:①照片影像质量:CR照片甲级片率67%,乙级片率26%,丙级片率7%,废片率0.25%。传统屏-片甲级片率36%,乙级片率50%,丙级片率11%,废片率2.5%。②照片诊断正确率:CR照片90%,传统屏-片73%。③摄影条件:CR系统比屏-片系统摄影管电压低4 kV,曝光量低4 mAs。结论:CR摄影影像质量好于传统屏-片摄影,可为临床提供可靠的诊断依据,且减少了病人的X线接受剂量。     

CR系统在X线摄影中的应用原理与临床价值

目的：探讨CR系统在X线摄影中的应用原理与临床价值。方法：对12000张胶片进行影像质量综合评估，分甲级片、乙级片、和废片三类。结果：甲级片占96％、乙级片占3．7％、废片占0．3％。结论：CR系统在X线摄影中其卓越的性能与数字化影像的特征有广泛的临床使用价值。     

CR系统在床边摄片中的临床应用

目的：探讨CR系统在床边摄片中的临床应用。方法：对2018张床边摄影X线胶片进行影像质量综合评估，分甲级片、乙级片和废片三类.结果：甲级片1874张，占92．9％，乙级片138张．占6．8％，废片6张．占0．3％，结论：CR系统床边摄片有明显优势，有着广泛推广价值。     

胸部低剂量数字化摄影参数的选择与影像质量的关系

目的 :探索数字摄影参数的合理选择与影像质量的关系。方法 :采用LDRD 0 1BL30型低剂量直接数字化X光机进行胸部摄影 ,选择 10 0 0例胸部影像进行质量分析 ,并参照“三甲”医院评定甲、乙、丙、废片的质量标准进行图像质量评定。结果 :数字摄影时由于体型、mAs、kV的选择不当 ,区域裁剪、窗宽窗位的调整不合理 ,从而影响甲级片的比例。结论 :为提高数字影像质量 ,需准确调节胸部数字化摄影各技术参数。     

直接数字摄影系统图像的质量控制

目的:探讨DDR影像质量控制的方法。材料和方法:按顺序抽取我院实行质量控制前、后的DDR照片各400份,依据照片甲片率的判定标准分别统计出甲、乙、丙片率及废片率,并分析非甲级片影响因素。对机器性能、曝光参数、技术员素质、后处理技术四个环节实行质量控制,采用相应有效质控措施。结果:质控组甲片率66%、乙片率29%、丙片率5%。非质控组甲片率41%、乙片率35%、丙片率23%。结论:实施质量控制能显著地提高DDR的影像质量。     

多功能直接数字化X线摄影系统的临床应用

目的探讨多功能直接数字化X线摄影系统(DDR)的临床应用,以期提高DDR的应用价值。方法利用EPEX型多功能DDR做常规摄影,随机调取1000张DDR影像,由3位高年资放射学者对影像进行分析,试图找出常用体位的最佳摄影方式。结果甲片率73.00%,乙片率22.70%,丙片率4.30%,废片率0%。结论DDR系统操作简单,成像快捷,影像质量好,有利于放射诊断。     

The Electronic Portal Imaging System Siemens Beamview Plus® Versus the Conventional Verification Films CEA-TVS® and DuPont CQL-7®A Critical Appraisal of Visual Image Quality

AIM: The aim of this study was the validation of the visual image quality of electronic portal imaging devices (EPID) and conventional verification films from the point of view of the end-viewers of portal films, the radiotherapists. MATERIAL AND METHODS: The verification image was represented in two different forms, viz. an electronic portal image employing Siemens Beamview Plus (on a computer monitor) and two different portal films using the conventional verification films CEA-TVS and DuPont CQL-7 (on a negatoscope). A total of 270 image sets (simulation film and portal image) were evaluated by each radiotherapist, evaluation extending to 90 sets of each type of verification film. Each set was evaluated by three specialists in radiotherapy examining subjective visual image quality whereby the following aspects served as evaluation criteria: contrast, artifacts, determination of actual radiation field edge position, anatomical structures and main structural feature for the determination of treatment field position. In addition, the anatomical structures employed for visual feature correlation between reference and portal films were classified according to their importance. RESULTS: In general the electronic portal image was rated significantly "visible" or better. Only the evaluation of artifacts showed an appreciable disadvantage for electronic portal imaging caused by physical artifacts due to radiographic technique and data processing aspects peculiar to the Siemens Beamview Plus 1.1. and also caused by different image processing tools reducing physical artifacts and enhancing the visibility of anatomical structures and likewise of anatomical artifacts (e.g. intestinal gas). By calculating the Spearman correlation coefficient to detect a possible relationship between the different criteria of subjective visual image quality, the research demonstrated that artifacts when limited to a tolerable proportion had no significant impact on the other criteria. CONCLUSIONS: As data of EPIDS are digital, images can be postprocessed and enhanced in a wide variety of ways. Using this tool the electronic portal imaging device provides images that, in terms of visual image quality, are at least comparable to the two evaluated types of radiographic films and also have the added advantage that such images are stored and can be transferred electronically being presupposition for digital patient documentation.     

Monitorbeurteilung digitalisierter und nachbearbeiteter Feldkontrollaufnahmen im Vergleich zu konventionellen Feldkontrollaufnahmen am Röntgenschaukasten

Purpose

Judgement of image quality and detail recognition of digitized and post-processed portal films presented on a computer monitor compared to the present standard, conventional portal films presented on a light-box.

Material and Methods

Conventional portal films of 3 different tumor sites (10 pelvis, 10 cranium, 10 vertebral column) were presented to a panel of 8 observers in 3 different manners: conventional film presented on a light-box (Conv), digitized non-post-processed images (Dig-1) and digitized post-processed images (Dig-2) presented on a high-resolution computer monitor. Subjective judgement of image quality, detail recognition and time requirement of conventional films compared to monitor presentation were evaluated using a 5-scaled questionnaire (from 1=much better to 5=much worse). Furthermore the observers had to point out predefined anatomical bony structures on the conventional films (Conv) as well as on the digitized post-processed images (Dig-2). Standard deviations of the landmarks outlined by 10 different observers were used as a criterion of objective detail recognition (Figure 1).

Results

Image quality of digitized post-processed images presented on the computer monitor was judged statistical significant better than of conventional films (pelvis 78%, vertebral column 62%, cranium 45% better) (Figure 3). Similar results were found for comparison of detail recognition: digitized post-processed images were scored better for pelvis in 81%, for vertebral column in 57%, for cranium in 40% (Figure 4, Table 1). Most benefit from portal film enhancement was found for pelvic images, where portal films are known to be of poor image quality (Figure 2). In contrast image quality of non-processed digital images compared to conventional films was graded worse (pelvis 69%, vertebral column 53%, cranium 71% worse) (Figure 4). Digital post-processed images were especially for the pelvis judged to require less time (pelvis 68%, vertebral column 26%, cranium 8% less time requirement) (Figure 5). For the pelvis a statistical significant decrease of standard deviations was found for Dig-2 compared to conventional films, indicating an objective increase of image quality and detail recognition (Table 2). In case of vertebral column and cranium no significant differences were evaluated (Table 3).

Conclusions

Digitized enhanced portal films presented on a computer monitor resulted in a quicker assessment and equal to better image quality as well as detail recognition compared to conventional films. Non-processed digitized images were judged to be of less image quality.     

足跟舟联合的X线研究

目的研究足跟舟联合的出现率及有关X线表现。方法收集1361例因足、踝外伤或疼痛就诊病例CR X线片,其中足部588例、踝部773例;年龄10~91岁,其中20~40岁984例。观察足及踝的跟舟联合显示率,分析男女足踝外伤、疼痛组的显示差异。结果1361例中显示跟舟联合5.3%(72/1361),足部8.7%(47/588),踝部3.2%(25/773),足部显示高于踝部(P<0.005)。足踝显示跟舟联合在两性别间、外伤及疼痛组间未见显著差异(P>0.05)。结论观察跟舟联合足部X线片优于踝部。     

Anterior cruciate ligament reconstruction using navigation: a comparative study on 60 patients

BACKGROUND: Poor outcome in anterior cruciate ligament reconstruction is often related to tunnel position. HYPOTHESIS: Improving accuracy of the tunnel position will lead to improved outcome. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Sixty patients were randomized to either standard instrumentation or computer-assisted guides to position the tibial and femoral tunnels. The results were evaluated on clinical outcome based on International Knee Documentation Committee form (laxity) and radiologic assessment: radiologic Lachman (Telos at 150 and 200 N) and analysis of the tunnel positions. RESULTS: International Knee Documentation Committee laxity was level A in 22 knees in the conventional group (mean, 1.5 mm at 200 N) compared with 26 navigated knees (mean laxity, 1.3 mm; P = .49). Laxity was less than 2 mm in 96.7% of the navigated group and 83% of the conventional group (P = .292). The variability of laxity in the navigated group was significantly less than in the conventional group, with the standard deviation of the navigated group being smaller than that in the conventional group (P = .0003 at 150 N and .0005 at 200 N Telos). A significant difference (P = .03) was found between the groups in the ATB value (distance between the projection of the Blumensaat line on the tibial plateau and the anterior edge of the tibial tunnel), characterizing the sagittal position of the tibial tunnel (negative ATB values imply graft impingement in extension). In the conventional group, mean ATB was -0.2 (-5 to +4), whereas it was 0.4 (0 to 3) in the navigated patients. There were no negative ATB values in the navigated group. CONCLUSION: This study confirms that the accuracy and consistency of tibial tunnel position can be improved by the use of computer-assisted navigation and that the clinical result in terms of laxity is more reliable.     

数字X线摄影和计算机X线摄影的应用比较与评价

探讨数字X线摄影(DR)和计算机X线摄影(CR)两大数字化摄影技术的临床应用.材料和方法:用德国Pehamed公司产测试板分别测量DR和CR的空间分辨率,并从100例两者所摄得的正位胸片中,分析图像质量,统计受检者的照射剂量,比较在技术操作、图像质量控制与后处理技术、工作效率、医院效益等方面的优势.结果:DR和CR均提高了图像质量,不同程度减低了被检者所受X线照射量,通过缩短检查和发报告的时间加快了工作效率,带来更高的效益,DR较之CR更具优势.结论:DR与CR相比DR图像质量、后处理功能、工作流程能力、病人吸收剂量均明显优于CR,DR具有更广阔的前景.     

CR与屏(铜)-片成像在头颈部肿瘤放疗射野影像验证中的比较应用

目的 评价计算机X线摄影(CR)与屏(铜)-片成像在头颈部肿瘤放疗射野影像验证中的应用价值.资料与方法 40张验证片中,20张采用传统屏(铜)-片摄影,20张采用CR摄影.由4名观察者分别对其进行评价,评价标准参照欧共体提供的影像标准,分"可见"、"再现"及"清晰再现"三级,取其平均百分比.采用SPSS 11.0统计软件包对观察者之间的一致性作方差分析.结果 CR的"可见"率为18.75%,"再现"率为71.25%,"清晰再现"率为10%;屏(铜)-片的"可见"率为71.25%,"再现"率为28.75%,"清晰再现"率为0.对比分析有意义的"再现"率与"清晰再现"率之和,CR组为81.25%,而屏(铜)-片组仅为28.75%.单因素方差分析结果显示观察者之间的一致性无统计学意义(P＞0.05).结论 CR成像在头颈部肿瘤放疗射野影像验证中较屏(铜)-片成像具有更好的显示效果.     

A New Verification Film System for Routine Quality Control of Radiation Fields: Kodak EC-L

BACKGROUND: The use of modern irradiation techniques requires better verification films for determining set-up deviations and patient movements during the course of radiation treatment. This is an investigation of the image quality and time requirement of a new verification film system compared to a conventional portal film system. MATERIAL AND METHODS: For conventional verifications we used Agfa Curix HT 1000 films which were compared to the new Kodak EC-L film system. 344 Agfa Curix HT 1000 and 381 Kodak EC-L portal films of different tumor sites (prostate, rectum, head and neck) were visually judged on a light box by 2 experienced physicians. Subjective judgement of image quality, masking of films and time requirement were checked. RESULTS: In this investigation 68% of 175 Kodak EC-L ap/pa-films were judged "good", only 18% were classified "moderate" or "poor" 14%, but only 22% of 173 conventional ap/pa verification films (Agfa Curix HT 1000) were judged to be "good". CONCLUSIONS: The image quality, detail perception and time required for film inspection of the new Kodak EC-L film system was significantly improved when compared with standard portal films. They could be read more accurately and the detection of set-up deviation was facilitated.     

持续优化技术在膝关节表面置换术失血损害控制中的作用

目的评价持续优化技术对行初次单侧人工膝关节表面置换术(TKA)围术期失血损害控制的临床疗效。方法回顾性分析2016年1月-2019年7月陆军军医大学第二附属医院骨科符合纳入排除标准的177例单侧初次TKA患者,根据不同假体类型分为两组试验,每组根据采用不同手术技术及围术期管理方式分为3组,具体如下:试验1均采用后交叉韧带替代型假体(posterior stabilization,PS)及手术技术,其中对照组1使用传统鸡尾酒(肾上腺素5mg、罗哌卡因300mg、复方倍他米松7mg、吗啡10mg,使用生理盐水配制至50mL),试验组1.1采用改良鸡尾酒(氨甲环酸1g、罗哌卡因300mg、复方倍他米松7mg、吗啡10mg,使用生理盐水配制至100mL),试验组1.2采用氨甲环酸序贯疗法。试验2均采用后交叉韧带保留型假体(posterior retaining,CR)及手术技术,其中对照组2为常规CR手术技术,试验组2.1为计算机导航辅助的CR手术技术,试验组2.2为经股内侧肌下入路微创CR手术技术。分别记录各组患者的术前术后血红细胞压积(HCT)、血红蛋白(HB)、术后引流量及输血率,计算围术期失血量。结果试验1:对照组1、试验组1.1、试验组1.2的术前术后HCT、HB、术后引流量均值分别为,HCT术前:37.3%、39.3%、39.8%;HB术前:121.2 g/L、128.4 g/L、129.6 g/L;HCT术后:28.3%、31.4%、32.0%;HB术后:90.8 g/L、100.9g/L、102.1g/L;术后引流量:205.6mL、99.5mL、62.5mL。改良"鸡尾酒"组较传统"鸡尾酒"组出血量平均下降198.6mL(GROSS方程)、153.6mL(HB-balance方程);氨甲环酸序贯疗法组较传统"鸡尾酒"组出血量平均下降203.9mL(GROSS方程)、141.9mL(HB-balance方程),以上差异均有统计学意义(P<0.05)。试验2:对照组2、试验组2.1、试验组2.2的术前术后HCT、HB、术后引流量均值分别为,HCT术前:39.8%、36.6%、39.8%;HB术前:129.8 g/L、119.3 g/L、127.5g/L;HCT术后:33.2%、30.1%、34.6%;HB术后:107.0 g/L、97.0 g/L、109.3g/L;术后引流量:58.8mL、63.5mL、48.6mL。计算机导航辅助CR手术技术组较常规CR手术技术组出血量平均上升61.6mL(GROSS方程),41.3 mL(HB-balance方程),差异无统计学意义(P>0.05);试验组2.2相比对照组2出血量平均下降159.8 mL(GROSS方程)、116.0 mL(HB-balance方程),差异有统计学意义(P<0.05)。结论改良"鸡尾酒"配方、氨甲环酸序贯治疗、经股内侧肌下入路微创手术技术,对于降低初次TKA的围术期失血量作用显著,而计算机导航辅助截骨TKA未见显著差异。     

Call obligations in radiology residency: a survey

RATIONALE AND OBJECTIVES: The authors evaluated the initial assignment of call responsibilities during residency, the effect on call obligations of the number of residents, and the differences between private and university programs and level 1 and non-level 1 trauma centers. MATERIALS AND METHODS: A survey was sent to all 203 diagnostic radiology residency programs accredited by the Accreditation Council for Graduate Medical Education. Chief residents at 21 institutions were surveyed by phone or in person. Directors of residency programs in the Graduate Medical Education Directory received the survey electronically. RESULTS: Responses were received from 99 (68 university, 31 private practice) of the 203 programs. Nine (9%) reported both a decreased number of residents and a subsequent increase in call obligations. First-year residents generally began to accept calls with a senior resident or alone at a median of 6 months, although 15 (48%) private practice programs required them to accept calls alone before this time. First-year residents at university programs (31%) were more likely to assume call duties during the first 6 months accompanied by a senior resident. Maximum time before 1st-year residents started going on call was 13 months. CONCLUSION: Call obligations remain a resident responsibility. University and private practice programs differ more than level 1 and non-level 1 trauma centers.