The use of digital magnification to reduce radiation dose in the cardiac catheter laboratory.

OBJECTIVES: To audit whether using magnification of images by use of a large viewing screen using digital matrix magnification which enlarges the image by 33% without using the X-ray machine zoom magnification protocols on a Siemens Artis Zee X-ray machine in a cardiac catheter laboratory results in a reduction of kerma-area product (KAP) for both diagnostic and interventional procedures. This reduction was predicted in an in vitro study in our laboratory, which has previously shown a 20.4% reduction in KAP. METHODS: A retrospective analysis was conducted of the radiation exposure to compare the measured KAP recorded during the period when conventional magnification with automatic brightness and dose control was used on a Siemens Artis Zee X-ray machine with a flat panel detector and when magnification settings were avoided by using a large screen to enlarge and project a non-magnified image by digital magnification. The analysis was carried out for patients having a diagnostic coronary angiogram and those having an interventional coronary procedure. RESULTS: For diagnostic coronary angiograms the median KAP per procedure in the period using conventional magnification was 2124.5 µGy.m2 compared to 1401 µGy.m2 when image matrix magnification was used, a 34% reduction (p < 0.0001). For interventional coronary procedures, the median KAP per procedure in the period using conventional magnification was 3791 µGy.m2 compared to 2568.5 µGy.m2 when image matrix magnification was used, a 32% reduction (p < 0.0001). CONCLUSION: Avoiding using conventional magnification in the cardiac catheter laboratory and using a large screen to magnify images was associated with a statistically significant greater than 30% reduction in KAP. ADVANCES IN KNOWLEDGE: This paper is the proof in clinical practice of a theoretical conclusion that radiation dose (KAP) is reduced by use of Image matrix magnification using a large viewing screen without the need to use X-ray tube magnification without significant loss of image resolution in interventional cardiology. The same approach will be useful in interventional radiology.

Comparison of testing of collimator and beam alignment, focal spot size with slit camera, and tube current consistency using computed radiography and conventional screen-film systems.

Conversion to a filmless technique of physical performance testing is becoming a topic of much interest to researchers. We assessed the use of a computed radiography (CR) system with postprocessing software as an alternative tool for performing the three physical performance tests of an x-ray tube. Collimator and beam alignment, focal spot size, and milliampere second (mAs) linearity, were performed using a CR system. Results were then compared with those obtained from a conventional screen-film (SF) system. The distances of collimator misalignment measured by the SF system were decreased while peak tube voltage (kVp) was increased (mAs was fixed), whereas those measured by CR were independent of exposure level. The degrees of beam collimator misalignment measured by the CR system were not different from those measured by the SF system. The differences in focal spot dimensions measured by SF and CR systems were less than 4% for large and small focal spot size in both width and length. The mAs linearity evaluated by the SF system agreed with those evaluated by the dose measurement at 50 kVp and 4 mAs, as well as 55 kVp and 3.2 mAs, while the mAs linearity test using the CR system agreed with those using the dose measurement method for all exposure levels. In summary, a CR system could be utilized to assess the three physical performance tests of a single x-ray tube, but required more time than an SF system. Medical physicists with image processing skills were needed to perform the analyses.

Inaccuracies in the Use of Magnification Markers in Digital Hip Radiographs.

BACKGROUND: With the ubiquity of digital radiographs, the use of digital templating for arthroplasty has become commonplace. Although improved accuracy with digital radiographs and magnification markers is assumed, it has not been shown. QUESTIONS/PURPOSES: We wanted to (1) evaluate the accuracy of magnification markers in estimating the magnification of the true hip and (2) determine if the use of magnification markers improves on older techniques of assuming a magnification of 20% for all patients. METHODS: Between April 2013 and September 2013 we collected 100 AP pelvis radiographs of patients who had a THA prosthesis in situ and a magnification marker placed per the manufacturer's instructions. Radiographs seen during our standard radiographic review process, which met our inclusion criteria (AP pelvic view that included a well-positioned and observed magnification marker, and a prior total hip replacement with a known femoral head size), were included in the analysis. We then used OrthoView(TM) software program to calculate magnification of the radiograph using the magnification marker (measured magnification) and the femoral head of known size (true magnification). RESULTS: The mean true magnification using the femoral head was 21% (SD, 2%). The mean magnification using the marker was 15% (SD, 5%). The 95% CI for the mean difference between the two measurements was 6% to 7% (p < 0.001). The use of a magnification marker to estimate magnification at the level of the hip using standard radiographic techniques was shown in this study to routinely underestimate the magnification of the radiograph using an arthroplasty femoral head of known diameter as the reference. If we assume a magnification of 20%, this more closely approximated the true magnification routinely. With this assumption, we were within 2% magnification in 64 of the 100 hips and off by 4% or more in only four hips. In contrast, using the magnification marker we were within 2% of true magnification in only 20 hips and were off by 4% or more in 59 hips. CONCLUSION: We found the use of a magnification marker with digital radiographs for preoperative templating to be generally inaccurate, with a mean error of 6% and range from -5% to 15%. Additionally, these data suggest that the use of a magnification marker while taking preoperative radiographs of the hip may be unnecessary, as simply setting the software to assume a 20% magnification actually was more accurate. LEVEL OF EVIDENCE: Level III, diagnostic study.

Phase-contrast and magnification radiography at diagnostic X-ray energies using a pseudo-microfocus X-ray source.

OBJECTIVE: To investigate the use of conventional diagnostic X-ray tubes for applications in which specialist microfocus sources are normally required. METHODS: A conventional diagnostic X-ray tube was used in conjunction with a range of apertures to investigate improvements in spatial resolution using a line-pairs test object. Phase-contrast effects were investigated by varying source-to-object and object-to-receptor distances using a 2-French catheter as a clinically realistic test object. RESULTS: For magnification radiography using a computed radiography receptor and conventional X-ray tube with a 1-mm nominal focus size, the limiting spatial resolution was improved from 3.55 line-pairs per millimetre, for a conventional contact image, to 5.6 line-pairs per millimetre, for a ×2 magnified view with a 250-µm aperture. For inline phase-contrast radiography, phase contrast enhancement of a 2-French catheter was demonstrated, and the expected trends with variations in source-to-object and object-to-receptor distances were found. Images of a neonatal phantom demonstrated a subtle improvement in visibility of a superimposed 1-French catheter simulating a percutaneously inserted central catheter for no increase in patient radiation dose. CONCLUSION: Spatial resolution improvement and visible phase contrast can be produced in clinically relevant objects using a pseudo-microfocus geometry at X-ray energies in the normal diagnostic range, using conventional diagnostic X-ray tubes and image receptors. The disadvantages of the proposal are the large distances required to produce phase contrast and limitations imposed by the resulting tube loading. ADVANCES IN KNOWLEDGE: It is possible to use conventional diagnostic X-ray equipment in applications that normally require microfocus X-ray sources. This presents some possibilities for clinical applications.

Distorsión en imágenes obtenidas mediante tomografía computarizada de cono / Distortion in cone-beam computed tomography images

Objetivo. Cuantificar la distorsión presente en imágenes de diferentes regiones del cráneo y la mandíbula humanos obtenidas mediante tomografía computarizada de cono. Metodología. Mediante el trazo de 3 planos horizontales y 4 verticales se delimitaron 15 cuadrantes en 30 cráneos secos humanos con las mandíbulas articuladas y se colocaron en cada cuadrante alambres de acero inoxidable en los planos sagital, coronal y axial (transversal). A cada espécimen debidamente posicionado se le tomó una tomografía computarizada de cono (CBCT). Se midió la longitud de los alambres, tanto en los especímenes óseos (medida real), como en las imágenes (medida tomográfica), para compararlas entre sí. Como pruebas estadísticas se utilizaron el Coeficiente de Correlación de Concordancia (CCC) y la Media de las Diferencias. Resultados. Dado que el CCC encontrado en todos los cuadrantes fue siempre mayor de 0,80, las medidas tomográficas que se hagan en estos cuadrantes pueden ser consideradas estadísticamente confiables. Sin embargo, los valores obtenidos en todas las medidas espaciales revelan que en todos los cuadrantes se presenta algún porcentaje de distorsión, siendo este de magnificación para algunos o de minimización para otros. La mayor distorsión se presentó en las medidas verticales de los cuadrantes situados en la línea mediana o próximos a ella, y el menor porcentaje en las medidas horizontales. Conclusión. La distorsión presente en las diferentes regiones del cráneo y la mandíbula no es estadísticamente significativa, pero es aconsejable tenerla en cuenta para minimizar los errores que puedan presentarse en la práctica clínica(AU)

Objective. To quantify the distortion in Cone-Beam Computed Tomography images of different regions of the human skull and mandible. Methods. With the tracing of three horizontal and four vertical planes, fifteen quadrants were delimited in thirty dry human skulls with their articulated jaws. Stainless steel wires were placed in the sagittal, coronal and transverse (axial) planes in each of the quadrants. A cone-beam computerized tomography (CBCT) was taken of each correctly positioned specimen and the wire lengths were measured in the bone specimens (real measure) and in the images (tomographic measure), for comparison. The Concordance Correlation Coefficient (CCC) and the Mean Differences statistical tests were applied to the data. Results. Since the CCC found for all the quadrants was always above 0.80, the tomographic measurements can be considered statistically reliable. However, the values obtained in all the spatial measurements revealed that in all the quadrants some percentage of distortion was present, being magnification for some and minification for others. The maximum distortion was present in the vertical measurements of the quadrants located in the middle line or close to it, and the minimum percentage in the horizontal measurements. Conclusion. The distortion present in the different regions of the skull and mandible is not statistically significant, but it is advisable to take it into consideration to avoid errors that can occur in the clinical practice(AU)

Digital magnification mammography with matched incident exposure: physical imaging properties and detectability of simulated microcalcifications.

Our purpose was to evaluate the usefulness of digital magnification mammography with matched incident exposure by investigating the physical imaging properties and doing an observer performance test. A computed radiography system and a mammographic unit were used in this study. Contact and magnification radiographies of 1.2-1.8 in combination with focal spot sizes of 0.1 mm without grid and 0.3 mm with grid were performed. Physical imaging properties, namely, scatter fraction, total modulation transfer function (MTF) including the presampled MTF and the MTF of focal spot size, and Wiener spectrum (WS), were measured. Detail visibility was evaluated by use of free-response receiver operating characteristic analysis of the detectability of simulated microcalcifications. Scatter fractions decreased considerably as the magnification factor increased without grid technique. In the grid technique, scatter fractions for all magnification techniques were comparable. The total MTFs of magnification techniques with a focal spot size of 0.1 mm improved significantly compared with the conventional contact technique. However, the improvement of the total MTFs of magnification techniques with the combination of 0.3 mm focal spot size was small. The WSs degraded with an increase of the magnification factor compared with the contact technique due to the maintained exposure incident on the object. The observer performance test indicated that the 1.8 magnification technique with the 0.1 mm focal spot size provided higher detectability than did the contact technique. Digital magnification mammography under the same incident exposure conditions improved the detectability of microcalcifications.

Can electronic zoom replace magnification in mammography? A comparative Monte Carlo study.

Magnification, which is considered to be a relatively high "dose cost" mammographic technique, is a complementary examination performed on women exhibiting breast complaints or abnormalities. Particular attention is given to the imaging procedure as the primary aim is to confirm the existence of suspected abnormalities, despite the additional dose. The introduction of post-processing capabilities and the widespread use of digital mammography promoted some controversy in the last decades on whether electronic zoom performed on the derived initial screening mammogram can effectively replace this technique. This study used Monte Carlo simulation methods to derive simulated screening mammograms produced under several exposure conditions, aiming to electronically magnify and compare them to the corresponding magnification mammograms. Comparison was based on quantitative measurements of image quality, namely contrast to noise ratio (CNR) and spatial resolution. Results demonstrated that CNR was higher for geometric magnification compared to the case of electronic zooming. The percentage difference was higher for lesions of smaller radius and achieved 29% for 0.10 mm details. Although spatial resolution is maintained high in the zoomed images, when investigating microcalcifications of 0.05 mm radius or less, only with geometric magnification can they be visualised.

A medição da grandeza practical peak voltage na prática radiológica / Measurement of the quantity practical peak voltage in the radiology practice

OBJETIVO: O objetivo deste trabalho foi estudar a grandeza practical peak voltage (PPV), determinada a partir da forma de onda de tensão aplicada a tubos radiológicos, e compará-la com algumas definições de kVp para diferentes tipos de geradores: monofásico (onda completa, clínico), trifásico (seis pulsos, clínico) e potencial constante (industrial). MATERIAIS E MÉTODOS: O trabalho envolveu a comparação do PPV medido invasivamente (utilizando um divisor de tensão) com a resposta de dois medidores comerciais não invasivos, além dos valores de outras grandezas usadas para medição da tensão de pico aplicada ao tubo de raios X, e a análise da variação do PPV com a ondulação percentual da tensão (ripple). RESULTADOS: Verificou-se que a diferença entre o PPV e as definições mais comuns de tensão de pico aumenta com o ripple. Os valores de PPV variaram em até 3 por cento e 5 por cento, respectivamente, na comparação entre medições invasivas e não invasivas feitas com os equipamentos trifásico e monofásico. CONCLUSÃO: Os resultados demonstraram que a principal grandeza de influência que afeta o PPV é o ripple da tensão. Adicionalmente, valores de PPV obtidos com medidores não invasivos devem ser avaliados considerando que eles dependem da taxa de aquisição e da forma de onda adquirida pelo instrumento.

OBJECTIVE: The present study was aimed at evaluating the practical peak voltage (PPV) determined from the voltage waveform applied to x-ray tubes and comparing it with some kVp definitions for different types of x-ray equipment: single-phase (full-wave) and three-phase (six-pulse) clinical x-ray generators, and an industrial constant potential apparatus. MATERIALS AND METHODS: The study involved the comparison between invasively measured PPV (with voltage dividers) and values obtained with two commercial noninvasive meters, besides values of other quantities utilized for measuring the x-ray tube peak voltage. The PPV variation with the voltage ripple was also analyzed in the present study. RESULTS: The authors observed that the difference between PPV and the most common peak voltage definitions increases with the ripple. PPV values varied up to 3 percent and 5 percent, respectively, in the comparison between invasive and non-invasive measurements with single-phase and three-phase devices. CONCLUSION: The results demonstrated that voltage ripple is the main quantity influencing the invasive or non-invasive PPV determination. Additionally, non-invasively measured PPV values should be evaluated taking into consideration their dependence on the data sample rate and waveform obtained by the device.

Calibration of radiographs by a reference metal ball affects preoperative selection of implant size.

The aim was to evaluate the impact of a reference ball for calibration of periapical and panoramic radiographs on preoperative selection of implant size for three implant systems. Presurgical digital radiographs (70 panoramic, 43 periapical) from 70 patients scheduled for single-tooth implant treatment, recorded with a metal ball placed in the edentulous area, were evaluated by three observers with the intent to select the appropriate implant size. Four reference marks corresponding to the margins of the metal ball were manually placed on the digital image by means of computer software. Additionally, an implant with proper dimensions for the respective site was outlined by manually placing four reference marks. The diameter of the metal ball and the unadjusted length and width of the implant were calculated. Implant size was adjusted according to a "standard" calibration method (SCM; magnification factor 1.25 in panoramic images and 1.05 in periapical images) and according to a reference ball calibration method (RCM; true magnification). Based on the unadjusted as well as the adjusted implant dimensions, the implant size was selected among those available in a given implant system. For periapical radiographs, when comparing SCM and RCM with unadjusted implant dimensions, implant size changed in 42% and 58%, respectively. When comparing SCM and RCM, implant size changed in 24%. For panoramic radiographs, comparing SCM and RCM changed implant size in 48%. The use of a reference metal ball for calibration of periapical and panoramic radiographs when selecting implant size during treatment planning might be advantageous.

The magnification of digital radiographs in the trauma patient: implications for templating.

INTRODUCTION: Digital radiographs are increasingly used for planning orthopaedic surgical procedures, despite the fact that they are frequently not calibrated to correct for magnification. The typical magnification of digital radiographs in the trauma patient has not yet been reported. The aims of this study were to assess the magnification of such radiographs, and to discuss if and when accurate calibration is required for trauma templating. MATERIALS AND METHODS: The operative notes and postoperative radiographs of 227 trauma patients were obtained. Each patient had undergone one of the following procedures: hip hemiarthroplasty, femoral nailing, tibial nailing, ankle plating, humeral nailing, humeral plating, or forearm plating. The dimensions of the implants used were measured on the uncalibrated postoperative radiographs using the hospital's Picture Archiving and Communication System software. The actual dimensions of the orthopaedic implants were obtained from the operation notes, and these were compared with the radiographic measurements. The intraobserver and interobserver variability of the radiographic measurements was also assessed. RESULTS: The radiographic magnification was greatest for the femoral head, and most variable for the femoral shaft. The magnification was least for the forearm. In general the magnitude and variability of magnification was least at the peripheries. There was good correlation between the measured and actual dimensions of the implants. The intraobserver and interobserver variability between the radiographic measurements was extremely small. CONCLUSION: Despite the ease and convenience of performing measurements on digital radiographs, these measurements are unreliable if the radiograph has not been calibrated. We believe that careful calibration of digital radiographs is essential for accurate templating in the trauma patient, although is less critical when templating the humeral canal, the tibial canal, the ankle and the forearm.

Results of a survey on digital screening mammography: prevalence, efficiency, and use of ancillary diagnostic AIDS.

OBJECTIVE: As the use of full-field digital screening mammography grows rapidly, this study was conducted to determine the time required to interpret digital soft-copy (filmless) mammography compared with conventional film-screen screening mammography and to evaluate radiologists' use of ancillary diagnostic aids when interpreting digital mammography (DM) and conventional film-screen mammography (FSM). MATERIALS AND METHODS: An 18-question survey was sent to 1,703 members of the Society of Breast Imaging, whose e-mail addresses were provided by the society. After subtracting those from whom out-of-office e-mail responses were received and three who wrote back to exclude themselves, there were 1,659 potential participants. Data from the respondents were collected and analyzed by tabulation and cross-tabulation. RESULTS: In total, 396 members of the Society of Breast Imaging completed and returned surveys, for a 23.9% response rate. Of the respondents, 49.0% said that they had access to and interpreted DM. Their estimated average time to read a single digital mammographic study was 2.6 minutes, compared with 2.0 minutes for reading a single film-screen mammographic study. Therefore, the perceived time difference was 0.6 minutes. Magnification was the main ancillary diagnostic aid used in interpreting both DM and FSM: 74.2% of respondents used computer-based magnification at least half the time in interpreting DM, and 90.9% used optical magnification at least half the time in interpreting FSM. Optical magnification was also used by 28.5% of respondents at least half the time in interpreting DM. The respondents also used computer-aided detection frequently: 91.0% and 76.3% of those who had computer-aided detection available said that they used it at least 75% of the time in interpreting DM and FSM, respectively. CONCLUSION: Digital mammography takes longer to interpret than FSM. Radiologists use various ancillary diagnostic aids, but magnification and computer-aided detection are the two most commonly used aids.

Rates of medial tibiofemoral joint space narrowing in osteoarthritis studies consistent despite methodological differences.

RATIONALE: Minimum tibiofemoral joint space width in the medial compartment (JSW) is the most well-established structural outcome measure for osteoarthritis (OA) of the knee. Its usefulness as a measure of therapeutic effectiveness in short-term studies is limited by the rate and variability of joint space narrowing (JSN) in the OA population. Microfocal radiography has been shown to improve reproducibility of JSW measurement compared to standard radiography, but measurement of magnification from microfocal knee films has been problematic, and JSN is yet to be investigated in a longitudinal microfocal study. OBJECTIVE: To establish the effect on JSW reproducibility of a new method of magnification measurement in microfocal radiographs. To report on and compare rates of medial tibiofemoral JSN and their variations in the placebo arms of microfocal and standard radiographic clinical trials in OA, using fluoroscopic semi-flexed (SF) knee positioning. To place in the context of published estimates of rates of JSN from comparable studies. METHODS: Using microfocal radiography, 36 patients were followed at a single centre for 2 years. Using standard radiography, 86 patients were followed for 1 year at a single centre, and 549 for 2 years in a multi-centre international study. Computerised JSW measurement was undertaken using enhanced and automated versions of existing algorithms. Rates of JSN were examined in the context of a review of published rates of JSN using a variety of techniques. RESULTS: Reproducibility of JSW measurement from microfocal radiographs was improved by the new magnification measurement. Rates of JSN were similar across the studies, but more variable when using standard radiography. The rates of JSN were also consistent with those from previously published investigations; all estimates since 2000, bar one, being consistent with the value 0.05 mm/year. CONCLUSION: Microfocal radiography using the new method lowered the variability of the rate of JSN, but the high cost and low availability of microfocal equipment remains a barrier to its more widespread use. The consistently low but highly variable rates of JSN seen in the review suggest that continued attempts to improve radiographic and mensural techniques are unlikely to significantly reduce required sample sizes.

Advances in biological structure, function, and physiology using synchrotron X-ray imaging*.

Studies of the physiology and biomechanics of small ( approximately 1 cm) organisms are often limited by the inability to see inside the animal during a behavior or process of interest and by a lack of three-dimensional morphology at the submillimeter scale. These constraints can be overcome by an imaging probe that has sensitivity to soft tissue, the ability to penetrate opaque surfaces, and high spatial and temporal resolution. Synchrotron X-ray imaging has been successfully used to visualize millimeter-centimeter-sized organisms with micrometer-range spatial resolutions in fixed and living specimens. Synchrotron imaging of small organisms has been the key to recent novel insights into structure and function, particularly in the area of respiratory physiology and function of insects. X-ray imaging has been effectively used to examine the morphology of tracheal systems, the mechanisms of tracheal and air sac compression in insects, and the function of both chewing and sucking mouthparts in insects. Synchrotron X-ray imaging provides an exciting new window into the internal workings of small animals, with future promise to contribute to a range of physiological and biomechanical questions in comparative biology.

Detection of simulated microcalcifications in a phantom with digital mammography: effect of pixel size.

PURPOSE: To evaluate the effect of pixel size on the detection of simulated microcalcifications in a phantom with digital mammography. MATERIALS AND METHODS: A high-spatial-resolution prototype imager that yields variable pixel size (39 and 78 microm) and a clinical full-field digital mammography (FFDM) system that yields a 100-microm pixel size were used. Radiographic images of a contrast-detail (CD) phantom were obtained to perform four-alternative forced-choice observer experiments. Polymethylmethacrylate was added to obtain phantom thicknesses of 45 and 58 mm, which are typical breast thicknesses encountered in mammography. Phantom images were acquired with both systems under nearly identical exposure conditions by using an antiscatter grid. Twelve images were acquired for each phantom thickness and pixel size (for a total of 72 images), and six observers participated in this study. Observer responses were used to compute the fraction of correctly detected disks. A signal detection model was used to fit the recorded data from which CD characteristics were obtained. Repeated-measures analyses with mixed-effects linear models were performed for each of the six observers. All statistical tests were two sided and unadjusted for multiple comparisons. A P value of .05 or less was considered to indicate a significant difference. RESULTS: Statistical analysis revealed significantly better CD characteristics with 39- and 78-microm pixel sizes compared with 100-microm pixel size for all disk diameters and phantom thicknesses (P<.001). Increase in phantom thickness degraded CD characteristics regardless of pixel size (P<.001). CONCLUSION: On the basis of the conditions of this study, reducing pixel size below 100 mum with low imaging system noise enhances the visual perception of small objects that correspond to typical microcalcifications.

Trends in image quality in high magnification digital specimen cabinet radiography.

Advances in microfocus X-ray tube design together with the availability of high resolution charge coupled device (CCD) detectors have led to the introduction of high magnification digital specimen cabinets for the examination of tissue samples. This paper explores the effect that the high magnification geometry permitted by such units has upon image quality in terms of phase contrast edge enhancement, spatial resolution and the appearance of test phantom images. Phase contrast effects and spatial resolution were studied using a previously established method (using edge profiles) and by computing the system spatial frequency response at various geometries. It was demonstrated that the magnitude of the phase contrast enhancement effect reaches a stable maximum at a magnification of x 4. It has also been shown that a continual increase in both the spatial resolution together with an improved signal to noise ratio occurs up to the maximum permissible magnification geometry, with effects of focal spot blur being negligible. In practice, the limited size of the digital detector and the difficulty of object alignment can constrain the use of the very high magnification option.

Inter-examiner and intra-examiner reliability of the measurement of marginal bone loss around oral implants.

The purpose of this study was to test whether a handheld magnifier could be used as an accurate instrument to examine the periapical radiographs and measure the marginal bone levels around dental implants system. A radiologic evaluation of marginal bone loss around 11 Astra Tech (Astra Tech AB, Mölndal, Sweden) oral implants was performed. A total of 22-recorded readings of mesial and distal bone loss were performed using a handheld magnifier with a graticule. There were 3 independent examiners who determined radiographic bone assessment. Thevalues of interclass correlation coefficient for the agreement between pairs of examiners showed a relatively high agreement (0.993 for A vs B, 0.995 for B vs C, and 0.995 for A vs C) and the same for intra-examiner reliability result (0.998 for B vs B). These results showed that a handheld magnifier could be used as a simple, reliable, and reproducible method for measuring bone loss around oral implants.

A quality assurance program in dental radiographic units in western Greece.

OBJECTIVE: This survey reports on successful efforts to establish a quality assurance (QA) program for 50 intraoral x-ray units in the public and private sectors in the region of Achaia, Greece. It was conducted in 2 phases, in 1996 and in 2003, including on-site inspections, QA tests, and standard questionnaires. The aim of the study was to assess equipment conditions, knowledge, and adoption of radiographic QA guidelines by general dentists and, more importantly, the impact of the recommendations and training provided. STUDY DESIGN: The tested parameters focused on radiation protection, equipment maintenance, film speed used, film processing conditions, and radiologic characteristics such as voltage, radiation leakage, type of collimation, source-to-skin distance, timer accuracy, and entrance dose. RESULTS: The data gathered in 1996 demonstrate minimal compliance with equipment function requirements and radiation safety measures. 1 The comparative evaluation of all the parameters gathered from the 2 surveys, indicated that in 2003 the vast majority of the dentists followed the recommendations given in 1996. Only 2 dentists persisted in neglecting the guidelines.

[Measurement of focal spot in X-ray tube using imaging plate].

Comparisons of focal-spot size measurements with a direct-exposure X-ray film, screen-film (S/F) system, and imaging plate (IP) were carried out for slit and star resolution pattern camera techniques. The focal-spot measurements of X-ray units with the nominal size of 0.1-1 mm were performed, and measurement using the computed radiography (CR) system was investigated. Compared with the direct-exposure X-ray film method, the measurements of focal-spot size by the S/F system were slightly small for all focal spots. The measurements obtained with IP were slightly large for large and small focal spots, although the measurement of micro focal-spot size was overestimated, extending the tolerance level owing to the sampling. With the star pattern camera technique, differences between the three kinds of detectors were minimal. Therefore, it was thought that measurement of focal-spot size using the CR system would be practical for both large and small focal spots if this method were used for quality control in medical facilities.