Full body low radiation radiography using Lodox Statscan

Lodox Statscan provides high-speed, high-quality, low radiation, full body imaging in a single scan, combined with three-dimensional reconstructive and zooming functionality. Several trauma centres have incorporated it into their advanced trauma life support protocol. This review gives a brief overview of the system.

A review of full-body radiography in nontraumatic emergency medicine

This paper reports on the application of full-body radiography to nontraumatic emergency situations. The Lodox Statscan is an X-ray machine capable of imaging the entire body in 13 seconds using linear slit scanning radiography (LSSR). Nontraumatic emergency applications in ventriculoperitoneal (VP) shunt visualisation, emergency room arteriography (ERA), detection of foreign bodies, and paediatric emergency imaging are presented. Reports show that the fast, full-body, and low-dose scanning capabilities of the Lodox system make it well suited to these applications, with the same or better image quality, faster processing times, and lower dose to patients. In particular, the large format scans allowing visualisation of a greater area of anatomy make it well suited to VP shunt monitoring, ERA, and the detection of foreign bodies. Whilst more studies are required, it can be concluded that the Lodox Statscan has the potential for widespread use in these and other nontraumatic emergency radiology applications.

How reliable and safe is full-body low-dose radiography (LODOX Statscan) in detecting foreign bodies ingested by adults?

OBJECTIVE: Foreign body ingestion is common and potentially lethal. This study evaluates the use of low-dose Statscans (LODOX) in emergency departments. DESIGN: This comparative cross-sectional study retrospectively assessed 28 289 digital chest x-rays and 2301 LODOX scans performed between 2006 and 2010 at a tertiary emergency centre. The radiographic appearance, image quality and location of ingested foreign bodies were evaluated in standard digital chest and LODOX radiography. The mean irradiation (μSv) and cumulative mean radiation dose per patient with the ingested foreign body were calculated according to literature-based data, together with the sensitivity and specificity for each modality. RESULTS: A total of 62 foreign bodies were detected in 39 patients, of whom 19 were investigated with LODOX and 20 with conventional digital chest radiography. Thirty-three foreign bodies were located in the two upper abdominal quadrants, 21 in the lower quadrants-which are not visible on conventional digital chest radiography-seven in the oesophagus and one in the bronchial system. The sensitivity and specificity of digital chest radiography were 44.4% and 94.1%, respectively, and for the LODOX Statscan 90% and 100%, respectively. The calculated mean radiation dose for LODOX investigations was 184 μS, compared with 524 μS for digital chest radiography. CONCLUSIONS: LODOX Statscan is superior to digital chest radiography in the diagnostic work-up of ingested foreign bodies because it makes it possible to enlarge the field of view to the entire body, has higher sensitivity and specificity, and reduces the radiation dose by 65%.

Comparison of different radiography systems in an experimental study for detection of forearm fractures and evaluation of the Müller-AO and Frykman classification for distal radius fractures

OBJECTIVES: We sought to compare the diagnostic performance of screen-film radiography, storage-phosphor radiography, and a flat-panel detector system in detecting forearm fractures and to classify distal radius fractures according to the Müller-AO and Frykman classifications compared with the true extent, depicted by anatomic preparation. MATERIALS AND METHODS: A total of 71 cadaver arms were fractured in a material testing machine creating different fractures of the radius and ulna as well as of the carpal bones. Radiographs of the complete forearm were evaluated by 3 radiologists, and anatomic preparation was used as standard of reference in a receiver operating curve analysis. RESULTS: The highest diagnostic performance was obtained for the detection of distal radius fractures with area under the receiver operating curve (AUC) values of 0.959 for screen-film radiography, 0.966 for storage-phosphor radiography, and 0.971 for the flat-panel detector system (P > 0.05). Exact classification was slightly better for the Frykman (kappa values of 0.457-0.478) compared with the Müller-AO classification (kappa values of 0.404-0.447), but agreement can be considered as moderate for both classifications. CONCLUSIONS: The 3 imaging systems showed a comparable diagnostic performance in detecting forearm fractures. A high diagnostic performance was demonstrated for distal radius fractures and conventional radiography can be routinely performed for fracture detection. However, compared with anatomic preparation, depiction of the true extent of distal radius fractures was limited and the severity of distal radius fractures tends to be underestimated.

Single-exposure dual-energy subtraction chest radiography: detection of pulmonary nodules and masses in clinical practice

The purpose of this retrospective study was to evaluate the impact of energy subtraction (ES) chest radiography on the detection of pulmonary nodules and masses in daily routine. Seventy-seven patients and 25 healthy subjects were examined with a single exposure digital radiography system. Five blinded readers evaluated first the non-subtracted PA and lateral chest radiographs alone and then together with the subtracted PA soft tissue images. The size, location and number of lung nodules or masses were registered with the confidence level. CT was used as standard of reference. For the 200 total lesions, a sensitivity of 33.5-52.5% was found at non-subtracted and a sensitivity of 43.5-58.5% at energy-subtracted radiography, corresponding to a significant improvement in four of five readers (p < 0.05). However, in three of five readers the rate of false positives was higher with ES. With ES, sensitivity, but not the area under the alternative free-response receiver operating characteristics (AFROC) curve, showed a good correlation with reader experience (R = 0.90, p = 0.026). In four of five readers, the diagnostic confidence improved with ES (p = 0.0036). We conclude that single-exposure digital ES chest radiography improves detection of most pulmonary nodules and masses, but identification of nodules <1 cm and false-positive findings remain a problem.

Comparative dose measurements by spiral tomography for preimplant diagnosis: the Scanora machine versus the Cranex Tome radiography unit

Objective. The purpose of this study was to determine the dose profile of the Cranex Tome radiography unit and compare it with that of the Scanora machine.Study design. The radiation dose delivered by the Cranex Tome radiography unit during the cross-sectional mode was determined. Single tooth gaps in regions 3 (16) and 30 (46) were simulated. Dosimetry was carried out with 2 phantoms, a head and neck phantom and a full-body phantom loaded with 142 thermoluminescent dosimeters (TLD) and 280 TLD, respectively; all locations corresponded to radiosensitive organs or tissues. The recorded local mean organ doses were compared with those measured in another study evaluating the Scanora machine.Results. Generally, dose values from the Cranex Tome radiography unit reached only 50% to 60% of the values measured for the Scanora machine. The effective dose was calculated as 0.061 mSv and 0.04 mSv for tooth regions 3 (16) and 30 (46), respectively. Corresponding values for the Scanora machine were 0.117 mSv and 0.084 mSv.Conclusion. Cross-sectional imaging in the molar region of the upper and the lower jaw can be performed with the Cranex Tome unit, which delivers only approximately half of the dose that the Scanora machine delivers.

The radiographic assessment of implant patients: decision-making criteria

Indications for the most frequently used imaging modalities in implant dentistry are proposed based on clinical need and biologic risk for the patient. To calculate the biologic risk, the authors carried out dose measurements. They demonstrated that the risk from a periapical radiograph is 20% of that from a panoramic radiograph. A panoramic radiograph and a series of 4 conventional tomographs of a single-tooth gap in the molar region carry 5% and 13% of the risk from computed tomography of the maxilla, respectively. Panoramic radiography is considered the standard radiographic examination for treatment planning of implant patients, because it imparts a low dose while giving the best radiographic survey. Periapical radiographs are used to elucidate details or to complete the findings obtained from the panoramic radiograph. Other radiographic methods, such as conventional film tomography or computed tomography, are applied only in special circumstances, film tomography being preferred for smaller regions of interest and computed tomography being justified for the complete maxilla or mandible when methods for dose reduction are followed. During follow-up, intraoral radiography is considered the standard radiographic examination, particularly for implants in the anterior region of the maxilla or for scientific studies. In patients requiring more than 5 periapical images, panoramic radiography is preferred.

Effective doses from scan projection radiographs of the head: impact of different scanning practices and comparison with conventional radiography

For CT scan planning, scan projection radiographs (SPR) are used. Tube tension and current for head SPR can be reduced to a minimum because of the small head diameter and because only high-contrast structures need to be visualized for planning. The goal of this study was to investigate SPR of the head in respect to effective doses, the influence of dose-reduction measures, and comparison with conventional x-ray.

Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery

This study compared periapical (PA) radiography and cone-beam tomography (CBT) for preoperative diagnosis in posterior maxillary teeth of consecutive patients referred for possible apical surgery. Images were concurrently analyzed by an oral radiologist and an endodontist to reach consensus in interpretation of the radiographic findings. The final material included 37 premolars and 37 molars with a total of 156 roots. CBT showed significantly more lesions (34%, p < 0.001) than PA radiography. Detecting lesions with PA radiography alone was most difficult in second molars or in roots in close proximity to the maxillary sinus floor. Additional findings were seen significantly more frequently in CBT compared with PA radiography including expansion of lesions into the maxillary sinus (p < 0.001), sinus membrane thickening (p < 0.001), and missed canals (p < 0.05). The present study highlights the advantages of using CBT for preoperative treatment planning in maxillary posterior teeth with apical pathology.

Pelvic radiography in ATLS algorithms: A diminishing role?

ABSTRACT: BACKGROUND: Pelvic x-ray is a routine part of the primary survey of polytraumatized patients according to Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard imaging technique in the diagnosis of pelvic fractures. This study was conducted to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis in favour of later pelvic examination by CT scan. METHODS: We conducted a retrospective analysis of all polytraumatized patients in our emergency room between 01.07.2004 and 31.01.2006. Inclusion criteria were blunt abdominal trauma, initial hemodynamic stability and a stable pelvis on clinical examination. We excluded patients requiring immediate intervention because of hemodynamic instability. RESULTS: We reviewed the records of n = 452 polytraumatized patients, of which n = 91 fulfilled inclusion criteria (56% male, mean age = 45 years). The mechanism of trauma included 43% road traffic accidents, 47% falls. In 68/91 (75%) patients, both a pelvic x-ray and a CT examination were performed; the remainder had only pelvic CT. In 6/68 (9%) patients, pelvic fracture was diagnosed by pelvic x-ray. None of these 6 patients was found having a false positive pelvic x-ray, i.e. there was no fracture on pelvic CT scan. In 3/68 (4%) cases a fracture was missed in the pelvic x-ray, but confirmed on CT (false negative on x-ray). None of the diagnosed fractures needed an immediate therapeutic intervention. 5 (56%) were classified type A fractures, and another 4 (44%) B 2.1 in computed tomography (AO classification). One A 2.1 fracture was found in a clinically stable patient who only received CT scan (1/23). CONCLUSION: While pelvic x-ray is an integral part of ATLS assessment, this retrospective study suggests that in hemodynamically stable patients with clinically stable pevis, its sensitivity is only 67% and it may safely be omitted in favor of a pelvic CT examination if such is planned in adjunct assessment and available. The results support the safety and utility of our modified ATLS algorithm. A randomized controlled trial using the algorithm can safely be conducted to confirm the results.

Could full-body digital X-ray (LODOX-Statscan) screening in trauma challenge conventional radiography?

ATLS Guidelines recommend single plain radiography of the chest and pelvis as part of the primary survey. Such isolated radiographs, usually obtained by bedside machines, can result in limited, low-quality studies that can adversely affect management. A new digital, low-radiation imaging device, the "Lodox Statscan" (LS), provides full-body anterior and lateral views based on enhanced linear slot-scanning technology in just over 5 minutes. We have the first LS in Europe at our facility. The aim of this study was to compare LS with computed tomographic (CT) scanning, as the gold standard, to determine the sensitivity of LS investigation in detecting injuries to the chest, thoracolumbar spine, and pelvis from our own experience, and to compare our findings with those of conventional radiography in the literature.

Comparison of intraoral radiography and limited cone beam computed tomography for the assessment of root-fractured permanent teeth

AIM: To compare intraoral occlusal (OC) and periapical (PA) radiographs vs. limited cone beam computed tomography (CBCT) in diagnosing root-fractured permanent teeth. MATERIAL AND METHODS: In 38 patients (mean age 24 years, range 8-52 years) with 44 permanent teeth with horizontal root fractures, intraoral radiographs (PA and OC) and limited CBCT were used to evaluate the location (apical, middle, cervical third of the root) and angulation of the fracture line. Furthermore, the conventional radiographs and CBCT images were compared for concordance of fracture location. RESULTS: In the PA and OC radiographs, 28 fractures (63.6%) were located in the middle third of the root, 11 (25.0%) in the apical third and 5 (11.4%) in the cervical third. The PA/OC radiographs and the sagittal CBCT images (facial aspect) yielded the same level of root fracture in 70.5% of cases (31 teeth; 95% CI: 54.1-82.7%). The PA/OC radiographs and sagittal CBCT images (palatal aspect) showed the same level of root fracture in 31.8% of cases. There was a statistically significant association between the angle at which the root fracture line intersected the axis of the tooth and the level of root fracture in the facial aspect of the sagittal CBCT images. CONCLUSIONS: The diagnosis of the location and angulation of root fractures based on limited CBCT imaging differs significantly from diagnostic procedures based on intraoral radiographs (PA/OC) alone. The clinical significance for treatment strategies and for the prognosis of root-fractured teeth has to be addressed in future studies.

[Head movements during simulated direct digital radiography]

The aim of this study was to simulate direct-digital cephalometric procedures and to record the head movements of probands. This study was prompted by the Committee for Insurance Matters of the Swiss National Invalidity Insurance which does not accept scanned digital cephalometric radiographs as a basis for its decisions. The reason for this is the required scanning time of several seconds during which even slight head movements can lead to kinetic blurring and landmark displacement. Incorrect angular measurements may result. By means of a Sirognathograph and a cephalostat of non-ferromagnetic material, the head movements of a total of 264 subjects were recorded in three dimensions, with a scanning time of up to 25 seconds. In a second series, the influence of a chin support to reduce head movements was also tested. The results of the first series of tests showed that, with an increasing scan time, movements became greater, mostly in the sagittal plane, and that maximum displacements could occur already at the start of the recording. With a scan time of 10 seconds the median movement amplitude in the vertical dimension was 2.14 mm. The second series of tests revealed a significant reduction in head movements in all dimensions owing to an additional stabilizing chin support. To minimize head movements, scanning times must be reduced and additional head stabilizing elements together with existing ones are necessary.