Reversible high-grade atrioventricular block with septal myocardial edema in Lyme carditis.

A 34-year-old road builder was admitted to the authors' emergency department due to progressive dyspnoea that had been present for 6 days. The patient had a history of excessive smoking (60 cigarettes/day). The medical history was otherwise unremarkable. A transient rash had occurred during work 2 weeks previously. The patient could not remember a bite. The electrocardiogram showed 2:1 atrioventricular (AV) block with narrow QRS complexes. D­dimer and C­reactive protein were slightly elevated; all other laboratory findings were within normal range. Echocardiography revealed normal findings. ELISA and western blot analysis confirmed acute Lyme disease. Cardiac magnetic resonance imaging (MRI) disclosed myocardial edema in the interventricular septum. Antibiotic treatment with ceftriaxone was initiated for 2 weeks. The heart block improved to a first degree AV block (PR interval 274 ms) at day 5 of treatment. At discharge, the patient had a normal PR interval of 190 ms. Follow-up cardiac MRI revealed almost complete regression of the cardiac septal edema.

[Resuscitation of a patient in the computed tomography unit]. / Der reanimationspflichtige Patient auf dem CT-Patiententisch.

An 80-year-old male patient presented with acute chest pain. Clinically an aortic dissection or pulmonary embolism was suspected therefore non-ECG-gated multislice computed tomography was performed and despite the lacking ECG gating the causative high grade coronary stenosis could be identified.

Impact on adenosine stress cardiac magnetic resonance for recanalisation and follow up of chronic total coronary occlusions.

OBJECTIVE: To evaluate the impact on cardiac magnetic resonance imaging (CMRI) with adenosine stress and delayed enhancement for indication and follow up after interventional recanalisation of chronic total coronary occlusions (CTOs). MATERIAL AND METHODS: Twenty consecutive patients (15 males; 5 females; mean age 65 years) with CTO verified by cardiac catheterisation referred to CMRI. Sixteen of them got CMRI before and after coronary recanalisation. Wall motion abnormalities (WMAs), first pass perfusion with adenosine and viability were assessed using a 1.5 T MR scanner (Sonata; Siemens). CMRI results were compared with clinical classifications, the results of cardiac catheterisation and follow up angiography. RESULTS: Sixteen patients had a successful recanalisation, 15 of the occluded coronary artery and one of collateral donor artery stenosis. After recanalisation all stress-induced progressive or new wall motion abnormalities (WMAs) of the corresponding segments and in the collateral donor territory (5 patients) and all adenosine induced perfusion defects (PD) or delay (12 patients) were regredient. 13/16 patients showed no transmural and one patient transmural delayed enhancement (DE) indicating myocardial scar. In 10/16 patients CSS grading of angina improved after recanalisation. CONCLUSION: After successful recanalisation of CTOs, patients with preinterventional stress-induced PDs and WMAs in viable myocardium did not display any signs of stress-induced ischemia postinterventionally. A comprehensive CMRI approach, including assessment of rest and stress WMAs, first pass perfusion and myocardial viability represents an important tool for the pre-interventional decision to recanalise CTOs and follow up.

Sonography of lung and pleura in pulmonary embolism: sonomorphologic characterization and comparison with spiral CT scanning.

STUDY OBJECTIVES: Despite the widespread use of lung scanning and angiography, pulmonary embolisms (PEs) remain undiagnosed in the majority of patients, suggesting the need for alternative diagnostic approaches. The present study investigates the clinical utility of transthoracic sonography (TS) for the diagnosis of PE and compares the data obtained with the technique to those obtained by spiral CT (sCT) scanning. DESIGN: This prospective study was performed using 69 patients with suspected PEs. TS was performed in all patients. In addition, sCT scanning was carried out in 62 patients. Other diagnostic procedures included the estimation of d-dimers, echocardiography, venous duplex sonography of the legs, pulmonary angiography, and ventilation/perfusion scanning. The diagnosis of PE was accepted when there was a conclusive result of these investigations or when an embolus could be visualized on a CT scan. SETTING: The Department of Pneumology in Friedrich-Schiller-University Hospital (Jena, Germany). PATIENTS: Sixty-nine patients (27 women and 42 men) with suspected PEs. RESULTS: A diagnosis of PE was established in 44 patients. Ninety-one peripheral parenchymal lesions (mean, 2.6 lesions per patient; range 1 to 9 lesions per patient) that are associated with PE were detected by TS in 35 patients (80%). Multiple, triangular, hypoechoic, and pleural-based parenchymal lesions with a localized and/or basal effusion were typical of the PEs as shown by TS. In nine patients with central PEs that had been diagnosed by CT scanning, no peripheral lesions could be detected by sonography. One patient with sonographic signs of PEs had a diffuse bronchogenic adenocarcinoma that was diagnosed at autopsy. In another patient with parenchymal lesions, pneumonia was diagnosed by CT scanning. The sensitivity of TS for detecting PEs was 80% (sensitivity of CT scanning, 82%), and the specificity of TS for detecting pulmonary lesions was 92% (specificity of CT scanning, 100%). The positive and negative predictive values of TS for the detection of PEs were 95% and 72%, respectively (positive predictive value for CT scanning, 100%; negative predictive value for CT scanning, 77%). The accuracy of TS was 84% (accuracy of CT scanning, 89%). CONCLUSIONS: TS is a noninvasive technique that is used for diagnosing parenchymal alterations, and it may serve as an additional method in the strategy for diagnosing PE.

[Reduction of radiation dosage by using digital luminescence radiography on a hand phantom]. / Reduktion der Strahlendosis mittels Speicherfolienradiographie am Handphantom.

PURPOSE: How much can the radiation dose be reduced for hand radiography by using digital luminescence radiography (DLR)? METHODS AND MATERIALS: A hand phantom (3M) with a cyst, two fractures and an "amputation" was digitally exposed in an anterior-posterior orientation using DLR (ADC-70, Agfa). The tube current time product (mAs) was reduced gradually while keeping the voltage constant. The surface entrance dose was measured by a Dosimax sensor (Wellhöfer). Five investigators evaluated the images for characteristics and critical features, pathological findings, visual resolution and contrast. RESULTS: The surface entrance dose at 50 kV/5 mAs was 31 microGy. The images could be evaluated very well down to an average dose of 36% (11 microGy); sufficient images were obtained down to an average dose of 26% (8 microGy). The resolution of the line pairs was the same or reduced by 1 level depending on the investigator. Contrast was assessed as being very good to sufficient. CONCLUSION: For the sufficient exclusion of a fracture the dose can be reduced to at least 39%, for the sufficient assessment of bony union and possible inflammatory changes to at least 42%, to position check and foreign body search to at least 23%. By DLR the following question-referred mAs-product at 50 kV are stated: fracture exclusion 2 mAs, bony union, arthritis and osteomyelitis 2.2 mAs, position check and foreign body search 1.25 mAs.

[Reduction of radiation exposure by using storage phosphor radiography on pelvis and lumbar spine]. / Reduktion der Strahlenexposition mittels Speicherfolienradiographie an Becken und Lendenwirbelsäule.

PURPOSE: To examine the reduction of radiation dose for radiography of the pelvis and lumbar spine (LS) by using storage phosphor radiography (SPR)? MATERIAL AND METHODS: Each pelvis and LS of 2 phantoms (3 M) and 2 corpses were X-raxed digitally in an anterior-posterior orientation using SPR (ADC compact, Agfa). The tube current time product (mAs) was diminished gradually while keeping the voltage constant. The surface entrance dose was measured by a Dosimax (Wellhöfer) sensor. Five investigators evaluated the images for characteristics and critical features and pathological findings. RESULTS: The images of the 4 various pelvises/LS could be evaluated sufficiently down to an average dose of 34 to 40 %/18 to 35 %. For the assessment of hip joint, region typical corticalis and calcifications (pelvis/LS) 9 to 18 %/8 to 23 % of the initial dose (initial dose is equivalent to a conventional screen film system with a speed class of 400) are enough, spongiosa typical for the region and the sacrum 30 to 56 %/19 to 36 % on average among the readers. CONCLUSION: For the sufficient exclusion of a fracture the dose can be reduced on pelvis/LS to at least 39 %/28 % ( 23 %/17 %), for the assessment of sacroiliitis/osteolyses/demineralisation to at least 78 %/44 % ( 34 to 36 %/22 to 26 %), to position check after fracture to at least 15 %/25 % ( 9 %/10 %). Question-related tube current time products of the pelvis and LS can be deduced for various objects.

[Radiation exposure of the ocular lens and thyroid gland in digital subtraction angiography of brain-supplying arteries]. / Strahlenexposition der Augenlinse und der Schilddrüse bei der Digitalen Subtraktionsangiographie der hirnversorgenden Arterien.

PURPOSE: To find out the individual level of radiation exposure of the ocular lens and thyroid gland during DSA of arteries supplying the brain, considering the indication. MATERIAL AND METHOD: The study was conducted on 72 patients during aortic arch and cerebral artery angiographies using thermoluminescent dosimetry. RESULTS: During 20 aortic arch angiographies the measured values were within non-critical limits, whereas during carotid, vertebral or cerebral four-vessel angiography of the left ocular lens exposure values of more than 500 mGy (max. 782 mGy) were stated in two of 52 cases. The highest measured exposure relating to the right ocular lens was 126 mGy, to the thyroid gland 88 mGy. However, in 51 of 52 cases thyroid gland doses of below 51 mGy were measured. In 71 of 72 cases there was a lateral difference between right and left lens exposure up to twice the measured dose for the right ocular lens during aortic arch angiographies and up to sixteen-fold in respect of the left lens during cerebral angiographies. CONCLUSION: In addition to the fluoroscopic time, number of images, fade-in and zoom some other dose-influencing factors, radiation geometry is especially decisive for organ exposure. The risk of cataracts or thyroid gland carcinomas/hypothyrosis can be neglected with median values of 40 and 70 mGy relating to the ocular lens and 17 mGy for the thyroid gland during cerebral angiographies.

[The reduction of the radiation dosage by means of storage phosphor-film radiography compared to a conventional film-screen system with a grid cassette on a skull phantom]. / Reduktion der Strahlendosis mittels Speicherfolienradiographie im Vergleich zum konventionellen Film-Folien-System mit Rasterkassette am Schädelphantom.

PURPOSE: How much can the radiation dose be reduced for skull radiography by using digital luminescence radiography (DLR) compared to a conventional screen film system with a grid cassette? METHODS AND MATERIALS: A skull phantom (3M) was x-rayed in anterior-posterior orientation using both a conventional screen film system with grid cassette and DLR (ADC-70, Agfa). The tube current time product (mAs) was diminished gradually while keeping the voltage constant. The surface entrance dose was measured by a sensor of Dosimax (Wellhöfer). Five investigators evaluated the images by characteristic and critical features, spatial resolution and contrast. RESULTS: The surface entrance dose at 73 kV/22 mAs was 0.432 mGy in conventional screen film system and 0.435 mGy in DLR. The images could be evaluated very well down to an average dose of 71% (0.308 mGy; SD 0.050); sufficient images were obtained down to an average dose of 31% (0.136 mGy; SD 0.065). The resolution of the line pairs were reduced down to 2 levels depending on the investigator. Contrast was assessed as being very good to sufficient. The acceptance of the postprocessed images (MUSICA-software) was individually different and resulted in an improvement of the assessment of bone structures and contrast in higher dose ranges only. CONCLUSION: For the sufficient assessment of a possible fracture/of paranasal sinuses/of measurement of the skull the dose can be reduced to at least 56% (phi 31%; SD 14.9%)/40% (phi 27%; SD 9.3%)/18% (phi 14%; SD 4.4%). Digital radiography allows question-referred exposure parameters with clearly reduced dose, so e.g. for fracture exclusion 73 kV/12.5 mAs and to skull measurement 73 kV/4 mAs.

31P-MR spectroscopic imaging in hypertensive heart disease.

Hypertensive heart disease (HHD) causes structural changes (e.g., fibrosis) that result in diastolic and systolic myocardial dysfunction. Alterations of (31)P metabolism and cardiac energy impairments were assessed in patients with HHD by MR spectroscopy (MRS) and correlated with left ventricular systolic function. Thirty-six patients with HHD and 20 healthy controls (mean age 35.2+/-10.7 years) were examined with (31)P-MRS at 1.5 T by using an ECG-gated CSI sequence. Twenty-five patients (mean age 64.3+/-9.3 years) had diastolic dysfunction, but preserved systolic function (HHD-D), whereas 11 patients (62.3+/-11.4 years) suffered from additional impaired systolic function (HHD-S). In both patient groups, the PCr/gamma-ATP ratio was lower than in the controls (controls: 2.07+/-0.17; P<0.001), and in HHD-S was lower than in HHD-D (1.43+/-0.21 vs. 1.65+/-0.25; P=0.012). PCr/gamma-ATP ratios were linearly correlated with LVEF (Pearson's r: 0.39; P=0.025). In the HHD-S group, the PDE/gamma-ATP ratio was significantly lower (0.56+/-0.36) than in the controls (1.14+/-0.42; P=0.001). In contrast to the group of HHD-D patients, whose slightly decreased PCr/gamma-ATP ratios compared to controls may be explained by age differences, the more distinct changes observed in HHD-S patients indicate an altered energy metabolism. The observed metabolic changes were related to functional impairments, as indicated by a reduced LVEF. Reduced PDE/ATP ratios indicate changes in the phospholipid metabolism.

Palliative portal vein stent placement for lymphatic recurrence of gastric cancer.

INTRODUCTION: Percutaneous transhepatic stenting of the main portal vein is a rare intervention. CASE REPORT: In the current patient, percutaneous angioplasty and stenting of a main portal vein stenosis due to lymphatic recurrence of gastric cancer ameliorated the progressing therapeutic restriction. The wall stent achieved portal venous patency that enabled ongoing chemotherapy. The stent remained patent for the entire subsequent survival period.

Noninvasive measurements of cardiac high-energy phosphate metabolites in dilated cardiomyopathy by using 31P spectroscopic chemical shift imaging.

Dilated cardiomyopathy (DCM) is accompanied by an impaired cardiac energy metabolism. The aim of this study was to investigate metabolic ratios in patients with DCM compared to controls by using spectroscopic two-dimensional chemical shift imaging (2D-CSI). Twenty volunteers and 15 patients with severe symptoms (left ventricular ejection fraction, LVEF<30%) and ten patients with moderate symptoms (LVEF>30%) of DCM were investigated. Cardiac 31P MR 2D-CSI measurements (voxel size: 40x40x100 mm3) were performed with a 1.5 T whole-body scanner. Measurement time ranged from 15 min to 30 min. Peak areas and ratios of different metabolites were evaluated, including high-energy phosphates (PCr, ATP), 2,3-diphosphoglycerate (2,3-DPG) and phosphodiesters (PDE). In addition, we evaluated how PCr/ATP ratios correlate with LVEF as an established prognostic factor of heart failure. The PCr/gamma-ATP ratio was significantly decreased in patients with moderate and severe DCM and showed a linear correlation with reduced LVEFs. PDE/ATP ratios were significantly increased only in patients with severe DCM as compared to volunteers. Applying 31P MRS with commonly-available 2D-CSI sequences is a valuable technique to evaluate DCM by determining PCr/ATP ratios noninvasively. In addition to reduced PCr/ATP ratios observed in patients suffering from DCM, significantly-increased PDE/ATP ratios were found in patients with severe DCM.

Digital radiogrammetry as a new diagnostic tool for estimation of disease-related osteoporosis in rheumatoid arthritis compared with pQCT.

OBJECTIVES: To investigate the potential of a new osteogeometric technology based on digital X-ray radiogrammetry (DXR) as a diagnostic tool for quantification of severity-dependent osteoporosis, and to distinguish between inflammation-mediated and corticoid-induced variations of bone mineralisation in patients suffering from rheumatoid arthritis. METHODS: Ninety-six patients (duration of disease: <18 months) underwent retrospective calculations of bone mineral density (DXR-BMD) and metacarpal index (MCI) by DXR, which were calculated from plain radiographs of the non-dominant hand. For comparison, pQCT-calculated BMD (total, cortical-subcortical and trabecular partition of bone tissue) was done on the distal radius. Severity was classified using Ratingen Score by two independent radiologists, and divided into three main groups. In addition, the patients were separated into those with corticoid medication (n=44; 5 mg/day over a half year period) and a control group (n=52) without any corticoid therapy. RESULTS: Correlations between DXR-BMD and MCI versus pQCT parameters were all significant (0.36

[The double aorta--rarity or artifact of ultrasound]. / Die doppelte Aorta--Rarität oder Artefakt im Ultraschall.

The double aorta is very rare. Only two cases are described in the literature. More frequent is a duplication artifact which is misinterpreted as being the image of a double aorta. This is caused by a refraction artifact which results from the difference in the velocity of sound between muscle tissue and fat tissue. Furthermore, a fat depot between parts of the rectus abdominis muscle has a prism-like effect. In most cases, this artifact can be avoided by lateral shifting of the transducer.

[Diagnosis of pulmonary embolism by transthoracic sonography. Sono-morphologic characterization of pulmonary lesions and comparison with spiral computed tomography]. / Diagnostik der Lungenembolie mittels transthorakaler Sonographie. Sonomorphologische Charakterisierung pulmonaler Läsionen und Vergleich mit der Spiral-Computertomographie.

BACKGROUND AND OBJECTIVE: Pulmonary embolism often extends to pleural surfaces, resulting in pleural-based parenchymal lesions. This study was carried out in order to evaluate the clinical value of transthoracic sonography (TS) for the diagnosis of pulmonary embolism. PATIENTS AND METHODS: A prospective study was performed in 45 patients (27 men, 18 women; mean age: 63.4 years; range: 24-88 years) with suspected pulmonary embolism. Transthoracic sonography was performed in all patients. In addition, helical computed tomography (CT) was carried out in 40 patients. Other diagnostic procedures included the estimation of D-dimeres, echocardiography, venous duplex sonography of the legs and ventilation/perfusion scanning. The diagnosis of pulmonary embolism was accepted when an embolus was detected on CT or as a conclusive result of the other investigations. RESULTS: Pulmonary embolism was established in 33 patients. Peripheral parenchymal lesions suspicious of pulmonary embolism were detected by transthoracic sonography in 26 patients (79%). In seven patients with central pulmonary embolism diagnosed by CT, no peripheral lesions could be detected by sonography. One patient with sonographic signs of pulmonary embolism had a diffuse bronchogenic adenocarcinoma which was diagnosed on autopsy. The sensitivity of transthoracic sonography (computed tomography) for pulmonary embolism was 79% (76%) and the specificity 92% (100%). The positive and negative predictive values of transthoracic sonography for the detection of pulmonary embolism were 96% and 61% (100% and 61%), respectively. The accuracy was 82% (82%). CONCLUSIONS: A substantial number of pulmonary emboli involve the peripheral lung areas. Transthoracic sonography is a non-invasive technique for diagnosing such parenchymal alterations and may serve as an alternative method in the diagnosis of pulmonary embolism.

[Imaging of coronary vascular abnormality with aneurysm and arteriovenous fistula using MRI bolus tracking]. / Darstellung einer Koronargefässanomalie mit Aneurysma und arteriovenöser Fistel mittels MRT-Bolustracking.

Coronary arteriovenous fistulas are very rare findings and predominantly drain into the right atrium or the right ventricle. Echocardiography and x-ray coronary angiography are established methods in the detection of this anomalies. It is reported on a patient, in whom an anomaly with dilatation of the circumflex coronary artery, aneurysma and drainage over an arteriovenous fistula in the right ventricle was observed. By means of magnetic resonance tomography with bolustracking technique the vessel course and the dynamics of perfusion are noninvasive shown beside the imaging using TSE-sequence. The method of multiple injections of 2 ml Gd-DTPA makes the bolustracking technique to an ideal tool for the determination of the individual vessel course, the haemodynamics and draining direction of an coronary anomaly with fistula.

Methods for the computational localization of atrio-ventricular pre-excitation syndromes.

BACKGROUND: The site of atrioventricular pre-excitation can roughly be estimated with the help of schemes basing on a few number of electrocardiogram (ECG) leads. Computer algorithms have been developed which utilize the body surface mapping of the pre-excitation signal for the localization purpose. We tested several new algorithms. METHOD: A patient suffering from Wolff-Parkinson-White syndrome was investigated prior the catheter ablation. The body surface mapping was performed with a 62-lead magnetocardiograph. The site of pre-excitation was calculated by using different methods: the dipole method with fixed and moving dipoles, the dipole scan on the endocardium, and different current density methods (L1 norm method, L2 norm method, low resolution electromagnetic tomography (LORETA) method, and maximum entropy method). Three-dimensional (3D) magnetic resonance imagings (MRIs) of the heart were used to visualize the results. The source positions were compared to the site of catheter ablation. RESULTS: The accessory pathway was successfully ablated left laterally. This site was correctly identified by the conventional dipole method. By scanning the entire endocardial surface of the heart with the dipole method we found a circumscribed source area. This area too, was located at the lateral segment of the atrio-ventricular grove. The current density methods performed differently. Whereas the L1 norm identified the site of pre-excitation, the L2 norm, the LORETA method and the maximum entropy method resulted in extended source areas and therefore were not suited for the localization purpose. CONCLUSION: The dipole scan and the L1 norm current density method seem to be useful additions in the computational localization of pre-excitation syndromes. In our single case study they confirmed the localization results obtained with the dipole method, and they estimated the size of the suspected source region.

Localization of late potential sources in myocardial infarction.

INTRODUCTION: Late potentials (LP) are markers of arrhythmogenic events after myocardial infarction (MI). The localization of LP sources would help to identify arrhythmogenic myocardium. The purpose of this study was to localize these LP sources from non-invasive body surface mapping data. METHODS AND RESULTS: Six patients were investigated with cardiac MRI and signal averaged 62-lead magnetocardiography after MI. Three of them were suffering from sustained ventricular tachycardia (VT). Sophisticated computer algorithms were used in order to compute the current density on the surface of the left ventricle. We compared these current density distributions for the entire QRS complex and the high frequency LP signals. In the three patients which had premature ventricular complexes (PVCs) we localized the exit sites of these arrhythmias. We found a close matching of the low current density areas based on the QRS complexes and the high current density areas based on the LP signals. These areas predominantly corresponded to sites of the infarctions. Exit sites of PVCs were located close to these areas. CONCLUSIONS: By means of sophisticated computer algorithms we were able to localize LP sources. This would be useful in steering catheter ablation and coronary revascularization therapies. However, the method has to be proven with the help of invasive mapping in a larger number of patients.

Potential clinical relevance of digital radiogrammetry for quantification of periarticular bone demineralization in patients suffering from rheumatoid arthritis depending on severity and compared with DXA.

The aim of this study was to investigate a new bone densitometric technology based on digital radiogrammetry (DXR) with respect to its ability to measure severity-dependent variations of bone mineralization in patients with rheumatoid arthritis. One hundred six randomly selected patients suffering from verified rheumatoid arthritis underwent digitally performed plain radiographs of the non-dominant hand and measurements of dual-energy X-ray absorptiometry (DXA) regarding total femur and lumbar spine. Using DXR the radiographs were analyzed retrospectively for bone mineral density (BMD) calculation. The severity was classified using Larsen score and Steinbroker stage blinded by two radiologists. A third radiologist reviewed the incongruently scored cases. Mean values of calculated parameters changed as follows from Larsen 1 to Larsen 5: Bone mineral density (DXR-BMD) decreased from 0.55 to 0.44 g/cm2 (p=0.000), DXR-MCI decreased from 0.44 to 0.33 (p=0.001), DXA-BMD (total femur) decreased from 0.92 to 0.78 g/cm2 (p=0.090) and DXA-BMD (lumbar spine) decreased from 0.91 to 0.84 g/cm2 (p=0.595). Similar results were verified for the Steinbroker stage. The relative decrease of BMD measured by DXR between the highest and lowest score was 20% for Steinbroker stage and Larsen score (p<0.05). The relative decrease of BMD using DXA revealed not such a significant result. Similar results were verified for metacarpal index (estimated by DXR). Correlations between BMD determined by DXR and by DXA were all significant (R=0.45 for lumbar spine and R=0.59 for total femur). Consequently, less than 35% of the DXR-BMD value is explainable by corresponding DXA values. The DXR-based BMD calculation seems to be able to distinguish severity and progress of the disease in contrast to those of DXA at lumbar spine and total femur.

The impact of technical conditions of X-ray imaging on reproducibility and precision of digital computer-assisted X-ray radiogrammetry (DXR).

OBJECTIVE: To evaluate the reproducibility of imaging and analysis for bone mineral density (BMD) determination using digital computer-assisted X-ray radiogrammetry (DXR; Pronosco X-posure, version V.2, Sectra Pronosco, Denmark); to verify potential factors that influence BMD extrapolation such as tube voltage, film-focus distance (FFD), film quality and brand (Kodak T-MAT-Plus, Konika SRH, Agfa Scopix), imaging technology (conventional, digital), imaging system (Kodak, Agfa) and exposure level (mAs); and to clarify whether DXR analysis based on printouts of digital images is comparable to analysis of conventional images. DESIGN AND PATIENTS: The hand of a cadaver was X-rayed using varied parameters: 4-8 mAs, 40-52 kV, 90-130 cm FFD. Radiographs under standardised conditions were performed 10 times using a conventional machine (Philips Super 80 CP) and the printouts of a digital system (Digital Diagnost Philips Optimus) for the analysis of reproducibility. One image was scanned and analysed 10 times additionally for imaging reproducibility. RESULTS: Reliability error of the system for the imaging process using conventional radiographs-rays was 0.49% (standard conditions: 6 mAs, 40 kV, 1 m FFD), using printouts of digital images was 2.89% (4 mAs, 42 kV, 1 m FFD) and regarding the analysis process was 0.22%. BMD calculation is not affected by alterations in FFD (precision error 1.21%), mAs (0.83%) or film quality/brand (0.38%), but differs significantly depending on tube voltage (2.70%). The system was not able to analyse conventional images with tube voltages of 49/52 kV. CONCLUSION: DXR technology is stable with most of the tested parameters. Normative data should exclusively be used for calculations using similar tube voltage or correction factors. All other parameters had no significant influence on the BMD calculation. Reproducibility is high. For technical reasons it is not recommended to use the printouts of digital images for BMD determination.