Role of digital X-ray study in the current diagnosis of gastric cancer

The authors attempted to assess and provide evidence for the expedience of using a digital radiography CR system in clinical gastroenterology. The prerequisite for this was the results of large-scale diagnostic studies of different organ and systemic diseases. The authors underline the specific features of application of this digital system: the latter allows several analogue X-ray apparatuses to be transformed to digital ones, provides economic efficiency as compared with apparatuses with the direct digitization of an image, shows telemedical prospects, and has low radiation loads as evidenced by research and experimental studies even in comparison with green systems, which makes the use of these digital systems in X-ray gastroenterology highly tempting. Based on a great body of data from 126 studies, the authors could show the effectiveness of the digital radiography CR system in the diagnosis of gastric cancer, demonstrate a modernized approach to formatting an obtained digital image, the possibility of postprocessor treatment that can enhance the validity of existing X-ray symptoms. This all permitted the authors to recommend using the CR systems in the diagnosis of gastric cancer, by taking into account the current obvious predominance of its morphological diffuse and mixed forms and corresponding difficulties of their endoscopic diagnosis.     

To the ways of the most reasonable implementation of digital radiography into the practical public health of the Russian Federation

The main idea of the authors' paper is to propose the most reasonable way of actively introducing the digital principle into the traditional roentgenological section of radiation diagnosis. For this, a luminophore digital radiography system has been chosen. The authors of the paper give a full-scale assessment and appropriate recommendations for its use. The paper essentially discusses the entire complex of matters that permit assessment whether its sound use is possible in regional and municipal health care systems. This is both a section devoted to a dose load, by making a comparative assessment of luminophore radiography and "the green system" and a study of different clinical diseases (456 cases). In their study, the authors have applied an original principle in the formation of an image obtained and some other approaches in order to make a comprehensive assessment of this method. In the authors' opinion, luminophore radiography has a variety of advantages. Firstly, this technique can be simultaneously applied to several nondigital apparatuses, including those available in the ward and it shows a rather diagnostic effectiveness and economic profitability, yields a qualitative image of varying density tissues upon single exposure, and has some other capacities of the CR system as a digital technique. All this things considered, the authors consider that luminophore radiography may be one of the main ways of introducing a digital technique into the conventional roentgenological section of radiation diagnosis at the level of regional and municipal heath care systems.     

Relationship of the specifications and informative value of digital X-ray study in pulmonary tuberculosis

Digital fluorographs used during mass chest screenings have different specifications that affect the diagnostic value of an obtained image. Visualization using on various apparatuses was compared in the context of early detection of tuberculosis of the most important skialogic signs of tuberculosis. The findings make it possible to substantively appraise the capacities of digital X-ray systems in detecting the early signs of tuberculosis and monitoring its process over time.     

A place of digital X-ray fluorography in the detection of lung diseases in the public health facilities of the Russian Federation

The paper shows the authors' opinion as to the use of digital X-ray fluorography (DXF) to detect pathology of the lung, primarily its tuberculosis and cancer from organizational-and-methodological and purely diagnostic standpoints. Based on a great body of data pooling 21,295 studies of patients, which comprised two (screening and routine clinical) groups, they authors state their views on the place and role of lung DXF in the work of public health facilities in the Russian Federation (RF). The objectivity of the authors' opinion is confirmed by the different nature of a lung abnormality detected by DXF at both the municipal and regional levels of the RF public health system and by a comparative analysis of the findings with those of film fluorography, routine X-ray study, linear tomography, X-ray computed tomography (XCT), and surgical evidence. The study has allowed the authors to express their opinion by recommending DXF as a method for primary diagnosis of lung diseases instead of film fluorography and routine X-ray study and to appreciate it in screenings. The authors' data indicate that XCT in its simplest variant rather than linear tomography should become the optimum method that specifies the diagnosis of lung diseases detected by DXT.     

Organizational and methodological approaches to using digital X-ray fluorography in the diagnosis of lung diseases in practical public health care of the Russian Federation

On the basis of a great body of information, the authors propose the most reasonable and effective organizational and methodological approaches to further actively introducing digital lung fluography into Russia's practical public health care. The paper discusses a diversity of topical problems associated with the practical use of digital X-ray fluorography (DXF), such as the assessment of its use depending on the level (municipal or regional) of public health care, methodological issues of its performance, current relationships of DXF and film fluorography; a place of DXF in the screening and routine clinical diagnosis of lung diseases. Great emphasis is laid on the role of DXF in the diagnosis of tuberculosis and cancer of the lung. The place and role of Russian manufacturers of digital lung fluorographs in the further development of SXF in practical public health care of Russia are also touched upon. The authors emphasize that replacement of film fluorography by digital one will present difficulties if regional and municipal health administrators do not take an active part in this matter.     

Place of digital X-ray fluorography in improving the diagnosis of pulmonary tuberculosis,lung cancer and mediastinal pathology

The prime objective of this paper is an effort to make a comprehensive assessment of a place of current digital X-ray fluorography in the diagnosis of various diseases of the lung, primarily its tuberculosis and cancer, and abnormalities of the mediastinum. The investigation used a principle of obligatory examination of the diagnostic potentialities of film X-ray study and digital X-ray fluorographic findings. Assessment of digital X-ray fluorography showed its potentialities of identifying an abnormality just on the monitor screen and through printer (paper) image reproduction. A total of 2,500 cases from different patient groups (those registered at a dispensary or identified at screening, those with a previously verified pathology). In addition to a particularly diagnostic section, the authors state their ideas on a multiplicity of organizational and methodological problems in the introduction of digital X-ray fluorography into practical public health of Russia. By defining "a diagnostic field" of application of the method, the authors restrict it only to the diagnosis of lung and mediastinal diseases.     

Characterization of the imaging settings in screening mammography using a tracking and reporting system: A multi-center and multi-vendor analysis

A tracking and reporting system was developed to monitor radiation dose in X-ray breast imaging. We used our tracking system to characterize and compare the mammographic practices of five breast imaging centers located in the United States and Brazil. Clinical data were acquired using eight mammography systems comprising three modalities: computed radiography (CR), full-field digital mammography (FFDM), and digital breast tomosynthesis (DBT). Our database consists of metadata extracted from 334,234 images. We analyzed distributions and correlations of compressed breast thickness (CBT), compression force, target-filter combinations, X-ray tube voltage, and average glandular dose (AGD). AGD reference curves were calculated based on AGD distributions as a function of CBT. These curves represent an AGD reference for a particular population and system. Differences in AGD and imaging settings were attributed to a combination of factors, such as improvements in technology, imaging protocol, and patient demographics. The tracking system allows the comparison of various imaging settings used in screening mammography, as well as the tracking of patient- and population-specific breast data collected from different populations.     

两种数字化影像信息检测系统图像质量与辐射剂量的比较研究

目的对比研究平板探测器和影像板两种数字化影像信息检测系统图像质量与辐射剂量的关系。方法应用DR和CR系统分别对对比度-细节体模（CDRAD2．0）进行不同辐射剂量的曝光成像。记录每次曝光的模体表面辐射剂量,将所获取的影像用CDRAD 2．0评估软件分析计算图像质量因子反数值IQFinv,并应用Spearman相关性检验和Wilcoxon秩和检验进行分析,比较两种数字化影像信息检测系统图像质量与辐射剂量的差异。结果在管电流量不同mAs时,DR系统的IQFinv值与CR的IQFinv值差异有统计学意义（P〈0．05）。结论辐射剂量相同时,平板探测器对于低对比度细节的检测能力优于影像板;在获得相同的图像质量时,与CR相比应用DR大大降低了被检者辐射剂量。     

Use of CR in the detection of present gastric cancer: diagnostic aspects

The authors describe the state-of-the-art of gastric cancer detection in detail and show the current principles of its radiodiagnosis. They provide a detailed explanation for that radiodiagnosis should be urgently returned into gastroenterology as an equal with endoscopy, which is based on the existing tendency for the major morphological types of gastric cancer to appear. The present-day capacities of radiodiagnosis of gastric cancer are mainly based on the introduction of the digital technologies into traditional radiology, which will replace the analog imaging principle in the foreseeable future. The authors present their data of examining 300 gastric cancer cases diagnosed by the CR system and later verified by a morphological study of resected gastric specimens. They emphasize that intraparietally growing gastric cancer is frequently inaccessible for endoscopy long, which determines the need for two basic procedures (radiodiagnosis and endoscopy) coexisting on a par for the detection of gastric cancer. They are sure that computed radiology (CR) will be the most acceptable way of changing traditional radiology to the digital imaging principle in primary, municipal health care in the near future.     

A GPU Simulation Tool for Training and Optimisation in 2D Digital X-Ray Imaging

Conventional radiology is performed by means of digital detectors, with various types of technology and different performance in terms of efficiency and image quality. Following the arrival of a new digital detector in a radiology department, all the staff involved should adapt the procedure parameters to the properties of the detector, in order to achieve an optimal result in terms of correct diagnostic information and minimum radiation risks for the patient. The aim of this study was to develop and validate a software capable of simulating a digital X-ray imaging system, using graphics processing unit computing. All radiological image components were implemented in this application: an X-ray tube with primary beam, a virtual patient, noise, scatter radiation, a grid and a digital detector. Three different digital detectors (two digital radiography and a computed radiography systems) were implemented. In order to validate the software, we carried out a quantitative comparison of geometrical and anthropomorphic phantom simulated images with those acquired. In terms of average pixel values, the maximum differences were below 15%, while the noise values were in agreement with a maximum difference of 20%. The relative trends of contrast to noise ratio versus beam energy and intensity were well simulated. Total calculation times were below 3 seconds for clinical images with pixel size of actual dimensions less than 0.2 mm. The application proved to be efficient and realistic. Short calculation times and the accuracy of the results obtained make this software a useful tool for training operators and dose optimisation studies.     

Image quality assessment with dose reduction using high kVp and additional filtration for abdominal digital radiography

PurposeDose reduction using additional filters with high kilovoltage peak (kVp) for abdominal digital radiography has received much attention recently. We evaluated image quality with dose reduction in abdominal digital radiography by using high kVp and additional copper filters at a tertiary hospital.MethodsBetween June 2016 and July 2016, 82 patients underwent abdominal digital radiography using 80 kVp in X-ray room 1 and 82 were imaged using 92 kVp with 0.1-mm copper filtration in X-ray room 2. The effective dose was calculated using a PC-based Monte Carlo program. Image quality of the abdominal radiography acquired in the two rooms was evaluated using a five-point ordinal scale, as well as the signal-to-noise and contrast-to-noise ratios.ResultsThe mean effective dose decreased by 25.8% and 25.7% for the supine and standing positions, respectively, when abdominal digital radiography using 92 kVp with 0.1-mm copper filtration was performed. In the 20 patients who performed abdominal digital radiography twice in each room, visual grading scores for visualisation of psoas outlines and kidney outlines are higher in room 1. However, there was no statistical significant difference of visual grading scores among the 124 patients who underwent only one abdominal radiography in the room 1 or 2 (P > 0.05).ConclusionsDose reduction for abdominal digital radiography can be achieved with comparable image quality by performing abdominal digital radiography using 92 kVp with 0.1-mm copper filtration, despite the higher AEC dose.     

DR全脊柱摄影技术在脊柱侧弯中的应用与优势

目的:探讨数字化X线摄影(DR)全脊柱摄像技术在脊柱侧弯中的应用和优势。方法:收集2012年2月至2013年6月于本院进行治疗的脊柱侧弯病例88例,应用数字化X线摄影(DR)技术对脊柱由上至下进行正位和侧位的扫描,均进行3次曝光,每两次曝光间隔均为9秒,曝光后通过图像拼接技术将患者脊柱图像进行拼接和重叠,形成全景图像,对全部患者的图像质量进行观察和评估。结果:所有入选病例中有84例患者图像清晰显示了脊柱侧弯的方向和角度、椎体和椎间隙、对称的椎弓根、根间距及对脏器的影响程度。其中1例因运动不合作出现伪影,3例曝光不足。全脊柱图像质量正位优秀率为92.43%,侧位优秀率为85.92%;全脊柱图像拼接正位优秀率为83.44%,侧位优秀率为86.58%。结论:数字化X线摄影(DR)技术应用上方便快捷,患者配合时间较短,图像质量较好,能够满足临床医生进行诊断和治疗,有助于患者预后康复情况的评估,值得在临床诊断中推广应用。     

Radiation diagnosis of tumors at four sites (the lung, breast, stomach, and large bowel) in the organizational and methodological standpoints of practical public health of the Russian Federation

The basic idea of the paper is to put forth today's vision of detecting tumors at four sites (cancer of the lung, breast, stomach, and large bowel) at the level of municipal and regional public health systems. Based on their many years' experience in "contacting" this pathology, the authors characterize the role and significance of basic radiation techniques applied to each of these four tumors, which should be used in their diagnosis. The authors also underline the need for reasonably certifying radiation diagnostic apparatuses for municipal and regional public health systems, which would efficiently combine their diagnostic and economic profitability, which will be able to avoid materializing the potential of expensive radiation equipment by just 15-20% of its built-in efficiency. By taking into account the present epidemiological situation with each of the tumors in question and scientific-and-technological achievements of current diagnostic equipment, the authors underline the need for correcting diagnostic approaches applied in their detection. The paper also presents the opinion of the authors as to selective screening. They are sure that it is impossible without its use to gain even some moderate improvement of the results of diagnosis and hence those of treatment of tumors at four sites, which are all responsible for 50% of all malignancy. The idea that it is necessary to actively return radiation studies to the diagnosis of cancer of the lung, breast, stomach, and large bowel runs throughout the paper. As applied to tumors at each of these sites, the authors express their opinion as to their radiation diagnosis. Naturally, they could not ignore the fact that the authorities of medical industry in our country should take an active part in the solution of organizational problems touched upon in the paper.     

Digital roentgen analysis as a tool for kinematic studies of the shoulder--a study of radiation dosage

The radiation exposure during biomechanical investigation of the shoulder joint done with a digital radiography system (Polytron 1000 VR - Siemens) was measured experimentally. Total radiation dose and surface dose were determined by phantom measurements. The radiation exposure per image is about 1/6 to 1/7 of that of a conventional study. The digital radiography system used is thus suitable for kinesiologic studies of large joints in healthy volunteers.     

Organization of lung digital X-ray fluorography and its introduction into the health care services of Russia

Based on comprehensive study of the capacities of digital X-ray fluorography (DXRF), the authors give their views on two main aspects of its use. These are firstly the most acceptable organizational forms of lung DXRF into the health care services of Russia and, secondly, its place in the diagnosis of pulmonary tuberculosis, lung cancer, chronic nonspecific lung diseases, and mediastinal tumors. As for its organization and introduction, the authors are against the fact that film fluorography should be rapidly replaced by DXRF. They give recommendations based on the reasonable and stepwise introduction of DXRF, which may rule out their negative perception versus the present attitude to the so-called prophylactic film fluorography. In the part dealing with diagnosis that analyzes 955 cases of various lung diseases (from over 8000 DXRFs) verified by different studies (morphological, cytological, etc.) and chest X-ray computed tomography, the authors show the results of monitoring imaging, by demonstrating all its potentialities. At the same time they recommend that image printing fixing should be also rather widely employed. In the authors' opinion, DXRF may become the method of choice in detecting pulmonary tuberculosis, lung cancer, chronic nonspecific lung diseases, and mediastinal tumors.     

Comparative evaluation of the diagnostic efficiency of interactive digital radiography and routine fluorography in screening examinations of the chest

The current trend for decreased exposure to medical ionizing radiation sources contributes to the introduction of novel technologies into radiation diagnosis. The aim of this study was to compare the informative value of interactive digital X-ray study and routine enlargement fluorography. The study covered 316 individual without the complaints typical of lung diseases. Three roentgenologists assessed X-ray images by 7 major signs. The sensitivity, specificity, and accuracy of the methods in question were defined. The final stage was the construction of routine operating curves (ROC). When there were diffuse changes in the lung, the sensitivity of interactive digital X-ray study was 14% higher. The higher informative value of interactive digital X-ray study is also attested by the higher position of a respective ROC. The fact that lung tissue function in combination with low radiation load may be estimated assumes the use of interactive digital X-ray study in patients with pneumosclerosis and emphysema.     

Current possibilities of X-ray diagnosis of small intestine diseases using the agent Entero-view

The paper analyzes the current capacities of routine (classical) X-ray study in the diagnosis of organ diseases of the small bowel. The distinctive feature of the paper is that in addition to routine barium passage through the small bowel, the new barium contrast agent Entero-view specially designed for its exploration is used. Of the 115 examined patients with various gastroenterological diseases, 76 underwent Entero-view examination that revealed different organ pathology of the small bowel in 28 cases (Crohn's disease in 18, tuberculosis in 3, lymphomas in 5, and cancer in 2). A normal X-ray pattern of the small bowel was diagnosed in 48 cases. The authors highly appreciate this agent. In their opinion, it is essentially helpful in solving one of the most difficult problems in X-ray gastroenterology--present-day X-ray diagnosis of small bowel pathology. The paper describes a procedure for using this agent. It gives a normal X-ray pattern of the small bowel, the agent's use has provided a particularly vivid image of both a normal part of the ileum and its different organ pathology-associated changes.     

Computed tomography in the x-ray diagnosis of pneumonia

Experience in the use of CT in combined radiodiagnosis of pneumonia was analysed. It has been concluded that CT objectively reflects morphological inflammatory pulmonary changes and permits their all-round assessment over time. The diagnosis of pneumonia in CT is based on classical x-ray symptoms. As compared to survey radiography CT reveals symptoms of pneumonia to the full at earlier stages. CT is an important additional method of investigation of inflammatory pulmonary diseases, but it should not be used separately without survey radiography. In a majority of cases when CT is performed there is no need in x-ray tomography.     

Synchrotron based planar imaging and digital tomosynthesis of breast and biopsy phantoms using a CMOS active pixel sensor

The SYRMEP (SYnchrotron Radiation for MEdical Physics) beamline at Elettra is performing the first mammography study on human patients using free-space propagation phase contrast imaging. The stricter spatial resolution requirements of this method currently force the use of conventional films or specialized computed radiography (CR) systems. This also prevents the implementation of three-dimensional (3D) approaches. This paper explores the use of an X-ray detector based on complementary metal-oxide-semiconductor (CMOS) active pixel sensor (APS) technology as a possible alternative, for acquisitions both in planar and tomosynthesis geometry.Results indicate higher quality of the images acquired with the synchrotron set-up in both geometries. This improvement can be partly ascribed to the use of parallel, collimated and monochromatic synchrotron radiation (resulting in scatter rejection, no penumbra-induced blurring and optimized X-ray energy), and partly to phase contrast effects. Even though the pixel size of the used detector is still too large – and thus suboptimal – for free-space propagation phase contrast imaging, a degree of phase-induced edge enhancement can clearly be observed in the images.     

床边CR的影像质量分析与临床应用

目的通过对床边CR摄影之胸片影像质量的分析,以便提供高质量影像图像服务于临床。方法对2008年6月-12月所有的床边CR胸片230份进行分析总结。结果CR胸片中符合或达到诊断要求的213份,占92.6%,余7.3%经过重摄后均达诊断要求。结合临床,床边CR的应用对胸部疾病的初步诊断的准确性较高约达80.1%。结论床边胸片影像质量可以符合使用要求,值得推广。