Active screening for pulmonary tuberculosis by chest x-ray among immigrants at the Swiss border

Summary : Aim: To assess the number of immigrants with pulmonary tuberculosis detected by chest x-ray screening at the Swiss border. Method: All adult immigrants entering Switzerland in 2004 were screened by chest x-ray (CXR). The number of radiological abnormalities suggestive of pulmonary tuberculosis, and the proportion requiring treatment for tuberculosis, were assessed retrospectively. The frequency of symptoms among immigrants with documented TB was compared with a sample of immigrants with a normal CXR. Results: Among 8995 immigrants, 8240 had a normal CXR, 630 had some abnormality not suggestive of active TB and 125 (1.4%) had a CXR suggestive of pulmonary TB. A final diagnosis of tuberculosis requiring treatment was made in SO (1 l with positive smear and culture, 16 with positive culture and 23 with negative culture), 57 had fibrotic lesions and 18 had another disease or a normal x-ray on control. The prevalence of symptoms did not differ between 27 immigrants with documented TB (smear+/culture+: 82%, smear-/ culture+: 75%), and 23 with smear-/culturetuberculosis (91%), but lower in 57 immigrants with fibrotic lesions (60%). Cough was more frequent among the 27 immigrants with documented TB (70%) than among 198 smokers without TB (37%) and among 229 non-smokers without TB (15%) Conclusions: Only 22% (27/125) of immigrants with CXR abnormalities suggestive of pulrnonary tuberculosis were documented by smear and/or culture and 40% (50/125) needed antituberculous treatment. 2/11 smear-positive immigrants would not have been detected by a questionnaire on symptoms. Rapport de synthèse : Le but de l'étude est d'évaluer le rendement du dépistage radiologique de la tuberculose pulmonaire chez les immigrés à l'entrée en Suisse. Méthode: parmi les immigrés adultes entrés en Suisse en 2004, qui ont tous passé un contrôle radiologique, le nombre de porteurs de clichés thoraciques suspects de tuberculose et la proportion de cas chez lesquels un traitement antituberculeux a été prescrit ont été évalués rétrospectivement. La fréquence des symptômes chez les immigrés atteints de tuberculose a été comparée à celle d'un groupe contrôle sans tuberculose. Résultats: parmi 8995 immigrés, 8240 avaient un cliché thoracique normal, 630 étaient porteurs d'une anomalie non suspecte de tuberculose active et 125 (1.4%) montraient des signes radiologiques suspects de tuberculose. Un diagnostic final de tuberculose nécessitant un traitement a été posé dans 50 cas (11 cas à frottis et culture positifs, 16 cas à culture positive, 23 cas à culture négative), 57 présentaient des lésions cicatricielles compatibles avec une ancienne tuberculose et 18 avaient une autre affection pulmonaire ou un cliché normal au contrôle. La prévalence des plaintes n'était pas différente entre les 27 immigrés porteurs d'une tuberculose documentée (frottis+ /culture+: 82%, frottis-/culture+ : 75%) et les 23 immigrés atteints d'une tuberculose non documentée (frottis-/culture-: 91%), mais elle était plus élevée que chez les 57 immigrés porteurs de lésions cicatricielles (59%). La toux était plus fréquente chez les 27 tuberculeux documentés (70%) que chez 198 fumeurs sans tuberculose (37%) et chez 229 non fumeurs sans tuberculose (15%). Conclusions: seuls 22% (27/125) des immigrés dont le cliché thoracique est suspect de tuberculose sont porteurs d'une tuberculose documentée par examen direct ou culture et 40% (50/125) nécessitent un traitement antituberculeux. Deux immigrants sur les 11 cas frottis positifs n'auraient pas été dépistés par un questionnaire.

Radiation doses in computed tomography: pitfalls in comparing CT to chest X-ray

Rapid response to : Madan M Rehani and Manorma Berry Radiation doses in computed tomography BMJ 2000; 320: 593-594

Creation of an Age-Adjusted, Dual-Energy X-ray Absorptiometry-Derived Trabecular Bone Score Curve for the Lumbar Spine in Non-Hispanic US White Women.

The trabecular bone score (TBS, Med-Imaps, Pessac, France) is an index of bone microarchitecture texture extracted from anteroposterior dual-energy X-ray absorptiometry images of the spine. Previous studies have documented the ability of TBS of the spine to differentiate between women with and without fractures among age- and areal bone mineral density (aBMD)-matched controls, as well as to predict future fractures. In this cross-sectional analysis of data collected from 3 geographically dispersed facilities in the United States, we investigated age-related changes in the microarchitecture of lumbar vertebrae as assessed by TBS in a cohort of non-Hispanic US white American women. All subjects were 30 yr of age and older and had an L1-L4aBMDZ-score within ±2 SD of the population mean. Individuals were excluded if they had fractures, were on any osteoporosis treatment, or had any illness that would be expected to impact bone metabolism. All data were extracted from Prodigy dual-energy X-ray absorptiometry devices (GE-Lunar, Madison, WI). Cross-calibrations between the 3 participating centers were performed for TBS and aBMD. aBMD and TBS were evaluated for spine L1-L4 but also for all other possible vertebral combinations. To validate the cohort, a comparison between the aBMD normative data of our cohort and US non-Hispanic white Lunar data provided by the manufacturer was performed. A database of 619 non-Hispanic US white women, ages 30-90 yr, was created. aBMD normative data obtained from this cohort were not statistically different from the non-Hispanic US white Lunar normative data provided by the manufacturer (p = 0.30). This outcome thereby indirectly validates our cohort. TBS values at L1-L4 were weakly inversely correlated with body mass index (r = -0.17) and weight (r = -0.16) and not correlated with height. TBS values for all lumbar vertebral combinations decreased significantly with age. There was a linear decrease of 16.0% (-2.47 T-score) in TBS at L1-L4 between 45 and 90 yr of age (vs. -2.34 for aBMD). Microarchitectural loss rate increased after age 65 by 50% (-0.004 to -0.006). Similar results were obtained for other combinations of lumbar vertebra. TBS, an index of bone microarchitectural texture, decreases with advancing age in non-Hispanic US white women. Little change in TBS is observed between ages 30 and 45. Thereafter, a progressive decrease is observed with advancing age. The changes we observed in these American women are similar to that previously reported for a French population of white women (r(2) > 0.99). This reference database will facilitate the use of TBS to assess bone microarchitectural deterioration in clinical practice.

Copper filtration in pediatric digital X-ray imaging: its impact on image quality and dose.

The effect of copper (Cu) filtration on image quality and dose in different digital X-ray systems was investigated. Two computed radiography systems and one digital radiography detector were used. Three different polymethylmethacrylate blocks simulated the pediatric body. The effect of Cu filters of 0.1, 0.2, and 0.3 mm thickness on the entrance surface dose (ESD) and the corresponding effective doses (EDs) were measured at tube voltages of 60, 66, and 73 kV. Image quality was evaluated in a contrast-detail phantom with an automated analyzer software. Cu filters of 0.1, 0.2, and 0.3 mm thickness decreased the ESD by 25-32%, 32-39%, and 40-44%, respectively, the ranges depending on the respective tube voltages. There was no consistent decline in image quality due to increasing Cu filtration. The estimated ED of anterior-posterior (AP) chest projections was reduced by up to 23%. No relevant reduction in the ED was noted in AP radiographs of the abdomen and pelvis or in posterior-anterior radiographs of the chest. Cu filtration reduces the ESD, but generally does not reduce the effective dose. Cu filters can help protect radiosensitive superficial organs, such as the mammary glands in AP chest projections.

X-ray microtomography of Larger Foraminifera

X-ray microtomography has become a new tool in earth sciences to obtain non-destructive 3D-image data from geological objects in which variations in mineralogy, chemical composition and/or porosity create sufficient x-ray density contrasts.We present here first, preliminary results of an application to the external and internal morphology of Permian to Recent Larger Foraminifera. We use a SkyScan-1072 high-resolution desk-top micro-CT system. The system has a conical x-ray source with a spot size of about 5µm that runs at 20-100kV, 0-250µA, resulting in a maximal resolution of 5µm. X-ray transmission images are captured by a scintillator coupled via fibre optics to a 1024x1024 pixel 12-bit CCD. The object is placed between the x-ray source and the scintillator on a stub that rotates 360°around its vertical axis in steps as small as 0.24 degrees. Sample size is limited to 2 cm due to the absorption of geologic material for x-rays. The transmission images are back projected using a Feldkamp algorithm into a vertical stack of up to 1000 1Kx1K images that represent horizontal cuts of the object. This calculation takes 2 to several hours on a Double-Processor 2.4GHz PC. The stack of images (.bmp) can be visualized with any 3D-imaging software, used to produce cuts of Larger Foraminifera. Among other applications, the 3D-imaging software furnished by SkyScan can produce 3D-models by defining a threshold density value to distinguish "solid" from "void. Several models with variable threshold values and colors can be imbricated, rotated and cut together. The best results were obtained with microfossils devoid of chamber-filling cements (Permian, Eocene, Recent). However, even slight differences in cement mineralogy/composition can result in surprisingly good x-ray density contrasts.X-ray microtomography may develop into a powerful tool for larger microfossils with a complex internal structure, because it is non-destructive, requires no preparation of the specimens, and produces a true 3D-image data set. We will use these data sets in the future to produce cuts in any direction to compare them with arbitrary cuts of complex microfossils in thin sections. Many groups of benthic and planktonic foraminifera may become more easily determinable in thin section by this way.

Synchrotron-based X-ray tomographic microscopy for rock physics investigations

Synchrotron radiation X-ray tomographic microscopy is a nondestructive method providing ultra-high-resolution 3D digital images of rock microstructures. We describe this method and, to demonstrate its wide applicability, we present 3D images of very different rock types: Berea sandstone, Fontainebleau sandstone, dolomite, calcitic dolomite, and three-phase magmatic glasses. For some samples, full and partial saturation scenarios are considered using oil, water, and air. The rock images precisely reveal the 3D rock microstructure, the pore space morphology, and the interfaces between fluids saturating the same pore. We provide the raw image data sets as online supplementary material, along with laboratory data describing the rock properties. By making these data sets available to other research groups, we aim to stimulate work based on digital rock images of high quality and high resolution. We also discuss and suggest possible applications and research directions that can be pursued on the basis of our data.

Correlations between trabecular bone score, measured using anteroposterior dual-energy x-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae.

Developing a novel technique for the efficient, noninvasive clinical evaluation of bone microarchitecture remains both crucial and challenging. The trabecular bone score (TBS) is a new gray-level texture measurement that is applicable to dual-energy X-ray absorptiometry (DXA) images. Significant correlations between TBS and standard 3-dimensional (3D) parameters of bone microarchitecture have been obtained using a numerical simulation approach. The main objective of this study was to empirically evaluate such correlations in anteroposterior spine DXA images. Thirty dried human cadaver vertebrae were evaluated. Micro-computed tomography acquisitions of the bone pieces were obtained at an isotropic resolution of 93μm. Standard parameters of bone microarchitecture were evaluated in a defined region within the vertebral body, excluding cortical bone. The bone pieces were measured on a Prodigy DXA system (GE Medical-Lunar, Madison, WI), using a custom-made positioning device and experimental setup. Significant correlations were detected between TBS and 3D parameters of bone microarchitecture, mostly independent of any correlation between TBS and bone mineral density (BMD). The greatest correlation was between TBS and connectivity density, with TBS explaining roughly 67.2% of the variance. Based on multivariate linear regression modeling, we have established a model to allow for the interpretation of the relationship between TBS and 3D bone microarchitecture parameters. This model indicates that TBS adds greater value and power of differentiation between samples with similar BMDs but different bone microarchitectures. It has been shown that it is possible to estimate bone microarchitecture status derived from DXA imaging using TBS.

Virtual anthropology: A comparison between the performance of conventional X-ray and MDCT in investigating the trabecular structure of long bones.

Recently, modern cross-sectional imaging techniques such as multi-detector computed tomography (MDCT) have pioneered post mortem investigations, especially in forensic medicine. Such approaches can also be used to investigate bones non-invasively for anthropological purposes. Long bones are often examined in forensic cases because they are frequently discovered and transferred to medico-legal departments for investigation. To estimate their age, the trabecular structure must be examined. This study aimed to compare the performance of MDCT with conventional X-rays to investigate the trabecular structure of long bones. Fifty-two dry bones (24 humeri and 28 femora) from anthropological collections were first examined by conventional X-ray, and then by MDCT. Trabecular structure was evaluated by seven observers (two experienced and five inexperienced in anthropology) who analyzed images obtained by radiological methods. Analyses contained the measurement of one quantitative parameter (caput diameter of humerus and femur) and staging the trabecular structure of each bone. Preciseness of each technique was indicated by describing areas of trabecular destruction and particularities of the bones, such as pathological changes. Concerning quantitative parameters, the measurements demonstrate comparable results for the MDCT and conventional X-ray techniques. In contrast, the overall inter-observer reliability of the staging was low with MDCT and conventional X-ray. Reliability increased significantly when only the results of the staging performed by the two experienced observers were compared, particularly regarding the MDCT analysis. Our results also indicate that MDCT appears to be better suited to a detailed examination of the trabecular structure. In our opinion, MDCT is an adequate tool with which to examine the trabecular structure of long bones. However, adequate methods should be developed or existing methods should be adapted to MDCT.

Bi-planar 2D-to-3D registration in Fourier domain for stereoscopic X-ray motion tracking

In this paper we present a new method to track bonemovements in stereoscopic X-ray image series of the kneejoint. The method is based on two different X-ray imagesets: a rotational series of acquisitions of the stillsubject knee that will allow the tomographicreconstruction of the three-dimensional volume (model),and a stereoscopic image series of orthogonal projectionsas the subject performs movements. Tracking the movementsof bones throughout the stereoscopic image series meansto determine, for each frame, the best pose of everymoving element (bone) previously identified in the 3Dreconstructed model. The quality of a pose is reflectedin the similarity between its simulated projections andthe actual radiographs. We use direct Fourierreconstruction to approximate the three-dimensionalvolume of the knee joint. Then, to avoid the expensivecomputation of digitally rendered radiographs (DRR) forpose recovery, we reformulate the tracking problem in theFourier domain. Under the hypothesis of parallel X-raybeams, we use the central-slice-projection theorem toreplace the heavy 2D-to-3D registration of projections inthe signal domain by efficient slice-to-volumeregistration in the Fourier domain. Focusing onrotational movements, the translation-relevant phaseinformation can be discarded and we only consider scalarFourier amplitudes. The core of our motion trackingalgorithm can be implemented as a classical frame-wiseslice-to-volume registration task. Preliminary results onboth synthetic and real images confirm the validity ofour approach.

Study of OSEM with different subsets in grating-based X-ray differential phase-contrast imaging.

Impressive developments in X-ray imaging are associated with X-ray phase contrast computed tomography based on grating interferometry, a technique that provides increased contrast compared with conventional absorption-based imaging. A new "single-step" method capable of separating phase information from other contributions has been recently proposed. This approach not only simplifies data-acquisition procedures, but, compared with the existing phase step approach, significantly reduces the dose delivered to a sample. However, the image reconstruction procedure is more demanding than for traditional methods and new algorithms have to be developed to take advantage of the "single-step" method. In the work discussed in this paper, a fast iterative image reconstruction method named OSEM (ordered subsets expectation maximization) was applied to experimental data to evaluate its performance and range of applicability. The OSEM algorithm with different subsets was also characterized by comparison of reconstruction image quality and convergence speed. Computer simulations and experimental results confirm the reliability of this new algorithm for phase-contrast computed tomography applications. Compared with the traditional filtered back projection algorithm, in particular in the presence of a noisy acquisition, it furnishes better images at a higher spatial resolution and with lower noise. We emphasize that the method is highly compatible with future X-ray phase contrast imaging clinical applications.

Investigation of discrete imaging models and iterative image reconstruction in differential X-ray phase-contrast tomography.

Differential X-ray phase-contrast tomography (DPCT) refers to a class of promising methods for reconstructing the X-ray refractive index distribution of materials that present weak X-ray absorption contrast. The tomographic projection data in DPCT, from which an estimate of the refractive index distribution is reconstructed, correspond to one-dimensional (1D) derivatives of the two-dimensional (2D) Radon transform of the refractive index distribution. There is an important need for the development of iterative image reconstruction methods for DPCT that can yield useful images from few-view projection data, thereby mitigating the long data-acquisition times and large radiation doses associated with use of analytic reconstruction methods. In this work, we analyze the numerical and statistical properties of two classes of discrete imaging models that form the basis for iterative image reconstruction in DPCT. We also investigate the use of one of the models with a modern image reconstruction algorithm for performing few-view image reconstruction of a tissue specimen.

Rosickyite (monoclinic gamma-sulphur) from La Presta Asphalt Mine, Neuchatel, Switzerland: new X-ray powder diffraction data

Rosickyite, the natural monoclinic gamma -form of sulphur, exists in only a few localities around the globe. In the old asphalt mine at La Presta, Neuchatel. Switzerland, rosickyite occurs locally as small, but very well formed crystals suitable for crystallographic studies. It grows as an alteration product of pyrite-rich asphalt. Rosickyite from La Presta mine is pure molecular sulphur, as revealed by gas chromatography-mass spectrometry. The X-ray powder diffraction data of La Presta rosickyite does not match the one previously published for this species. Therefore, a single crystal study was undertaken and a new indexed X-ray powder diffraction diagram for natural rosickyite is proposed.

Repositioning precision of coronary arteries measured on X-ray angiography and its implications for coronary MR angiography.

BACKGROUND: To test the hypothesis that intervals with superior beat-to-beat coronary artery repositioning precision exist in the cardiac cycle, to design a coronary MR angiography (MRA) methodology in response, and to ascertain its performance. METHODS: Coronary repositioning precision in consecutive heartbeats was measured on x-ray coronary angiograms of 17 patients and periods with the highest repositioning precision were identified. In response, the temporal order of coronary MRA pulse sequence elements required modification and the T2 -prep now follows (T2 -post) rather than precedes the imaging part of the sequence. The performance of T2 -post was quantitatively compared (signal-to-noise [SNR], contrast-to-noise [CNR], vessel sharpness) to that of T2 -prep in vivo. RESULTS: Coronary repositioning precision is <1 mm at peak systole and in mid diastole. When comparing systolic T2 -post to diastolic T2 -prep, CNR and vessel sharpness remained unchanged (both P = NS) but SNR for muscle and blood increased by 104% and 36% (both P < 0.05), respectively. CONCLUSION: Windows with improved coronary repositioning precision exist in the cardiac cycle: one in peak systole and one in mid diastole. Peak-systolic imaging necessitates a re-design of conventional coronary MRA pulse sequences and leads to image quality very similar to that of conventional mid-diastolic data acquisition but improved SNR. J. Magn. Reson. Imaging 2015;41:1251-1258. © 2014 Wiley Periodicals, Inc.

Number of X-ray examinations performed on paediatric and geriatric patients compared with adult patients.

The age of the patient is of prime importance when assessing the radiological risk to patients due to medical X-ray exposures and the total detriment to the population due to radiodiagnostics. In order to take into account the age-specific radiosensitivity, three age groups are considered: children, adults and the elderly. In this work, the relative number of examinations carried out on paediatric and geriatric patients is established, compared with adult patients, for radiodiagnostics as a whole, for dental and medical radiology, for 8 radiological modalities as well as for 40 types of X-ray examinations. The relative numbers of X-ray examinations are determined based on the corresponding age distributions of patients and that of the general population. Two broad groups of X-ray examinations may be defined. Group A comprises conventional radiography, fluoroscopy and computed tomography; for this group a paediatric patient undergoes half the number of examinations as that of an adult, and a geriatric patient undergoes 2.5 times more. Group B comprises angiography and interventional procedures; for this group a paediatric patient undergoes a one-fourth of the number of examinations carried out on an adult, and a geriatric patient undergoes five times more.