Comparison between Magnification Techniques and Direct Vision in Thyroid Surgery: A Systematic Review and Meta-Analysis.

Background and Objectives: The most common complications after conventional thyroid surgery in adult patients are recurrent laryngeal nerve (RLN) injury and hypocalcemia. Magnification techniques (surgical loupes or surgical microscope) are used for identification of RLN and parathyroid glands to diminish these complications although more evidence is necessary to assess their safety and efficacy in comparison with direct vision. Methods and Materials: Electronic databases (Pubmed, Cochrane Library, Scopus) as well as gray literature sources were searched for randomized controlled trials (RCTs) comparing the frequency of transient/permanent RLN injury and hypocalcemia after thyroid surgery by using magnification techniques and direct vision for identification of RLN and parathyroid glands until October 17, 2019. The main outcomes were transient/permanent RLN injury and hypocalcemia. For all outcomes, 95% confidence intervals (95% CI) were used. Statistical analysis was performed with RevMan 5.3. Results: Systematic review and meta-analysis included 3 RCTs with 437 patients overall. Magnification techniques did not significantly affect the risk of occurrence of transient RLN injury (OR = 0.38, 95% CI (0.11-1.35), I2 = 0%) and transient hypocalcemia (OR = 0.31, 95% CI (0.09-1.09), I2 = 23%) compared with direct vision. Included RCTs demonstrated only two patients with permanent hypocalcemia and another one with permanent RLN injury, who belonged to the direct vision group. Conclusion: The use of magnification techniques for identification of RLN and parathyroid glands seems to be as safe as direct vision. However, they do not decrease the risk of RLN injury and transient hypocalcemia after thyroid surgery compared with direct vision. Finally, further prospective research should be conducted as the sample among the studies was small.

Validation study for development of the Japan NBI Expert Team classification of colorectal lesions.

BACKGROUND AND AIM: The Japan narrow-band imaging (NBI) Expert Team (JNET) was organized to unify four previous magnifying NBI classifications (the Sano, Hiroshima, Showa, and Jikei classifications). The JNET working group created criteria (referred to as the NBI scale) for evaluation of vessel pattern (VP) and surface pattern (SP). We conducted a multicenter validation study of the NBI scale to develop the JNET classification of colorectal lesions. METHODS: Twenty-five expert JNET colonoscopists read 100 still NBI images with and without magnification on the web to evaluate the NBI findings and necessity of the each criterion for the final diagnosis. RESULTS: Surface pattern in magnifying NBI images was necessary for diagnosis of polyps in more than 60% of cases, whereas VP was required in around 90%. Univariate/multivariate analysis of candidate findings in the NBI scale identified three for type 2B (variable caliber of vessels, irregular distribution of vessels, and irregular or obscure surface pattern), and three for type 3 (loose vessel area, interruption of thick vessel, and amorphous areas of surface pattern). Evaluation of the diagnostic performance for these three findings in combination showed that the sensitivity for types 2B and 3 was highest (44.9% and 54.7%, respectively), and that the specificity for type 3 was acceptable (97.4%) when any one of the three findings was evident. We found that the macroscopic type (polypoid or non-polypoid) had a minor influence on the key diagnostic performance for types 2B and 3. CONCLUSION: Based on the present data, we reached a consensus for developing the JNET classification.

Impact of malpositioning on panoramic radiography in implant dentistry.

OBJECTIVES: The widely used panoramic radiography as a special kind of tomography underlies intrinsic procedural restrictions such as poor definition, inconsistent magnification, geometric distortion and spatial depositioning of objects situated outside the focal trough. This results in a non-anatomic display of the radiographed anatomic structures. Individual mandibular angle and width of the jaws, adjustment of the focal trough, jaw incongruence as well as patient positioning increase the inconsistency in display of the radiographed objects. This study precisely evaluated the quantitative impact of object malpositioning on the display in panoramic radiography. MATERIALS AND METHODS: A special dental implant model was highly accurate three dimensionally malpositioned and panoramic radiographs were taken. Automated image analysis was performed to exclude subjective assessment error. RESULTS: Precise and retraceable object deposition of up to 5 mm or 5° resulted in relevant deposition of objects and significant changes in object size and inter-object distances in the panoramic image. Unidirectional malpositioning lead to multiple errors in display. CONCLUSIONS: The extent of malpositioning-related display errors additionally to the known physicotechnical insufficiencies of the panoramic radiography demonstrates its limitations in precisely interpreting spatial relationships. CLINICAL RELEVANCE: Measurements within the panoramic radiography must not claim reliability. For a single object securely positioned in the focal trough and perpendicular to the central X-ray beam, measurements may be trustworthy on clinical scale. Once sterical relationships to other structures are evaluated, reliability must be questioned.

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)

Measurement accuracy with a new dental panoramic radiographic technique based on tomosynthesis.

OBJECTIVE: To investigate measurement errors and head positioning effects on radiographs made with new dental panoramic radiograph equipment that uses tomosynthesis. MATERIALS AND METHODS: Radiographic images of a simulated human head or phantom were made at standard head positions using the new dental panoramic radiograph equipment. Measurement errors were evaluated by comparing with the true values. The phantom was also radiographed at various alternative head positions. Significant differences between measurement values at standard and alternative head positions were evaluated. Magnification ratios of the dimensions at standard and alternative head positions were calculated. RESULTS: The measurement errors were small for all dimensions. On the measurements at 4-mm displacement positions, no dimension was significantly different from the standard value, and all dimensions were within ±5% of the standard values. At 12-mm displacement positions, the magnification ratios for tooth length and mandibular ramus height were within ±5% of the standard values, but those for dental arch width, mandibular width, and mandibular body length were beyond ±5% of the standard values. CONCLUSIONS: Measurement errors on radiographs made using the new panoramic radiograph equipment were small in any direction. At 4-mm head displacement positions, no head positioning effect on the measurements was found. At 12-mm head displacement positions, the measurements for vertical dimensions were little affected by head positioning, while those for lateral and anteroposterior dimensions were strongly affected.

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.

Assessment of magnification of digital pelvic radiographs in total hip arthroplasty using templating software.

INTRODUCTION: Templating of pelvic radiographs traditionally involved using implant-company provided acetates which assumed a magnification of 115-120%. With the introduction of digital imaging, many departments are becoming filmless. Templating software has been designed to allow on-screen templating of digital images. Knowledge of the true magnification of the image is required for accurate measurement. PATIENTS AND METHODS: Fifty consecutive postoperative pelvic radiographs were analysed using templating software. The implanted component was measured using an assumed magnification factor of 115%. The template image was then reset to the known component size, and the magnification factor was adjusted until the template covered the true component. RESULTS: An assumed magnification factor of 115% oversized the acetabular component by a mean of 6 mm (three component sizes) in all 50 components. The mean true magnification in our department was 127%. CONCLUSIONS: Validation of the true magnification produced by a radiology department using templating software is a simple and reproducible technique. It is recommended to all departments using digital images and templating software. Assumption of a magnification factor of 115% risks oversizing components by 6 mm.

Image quality in partially erased DenOptix storage phosphor plates.

This study aimed at investigating the effect of the partial erasing of DenOptix system storage phosphor plates on the image quality of digital radiographs. Standardized digital radiographs were acquired of a phantom mandible, using size 2 intraoral DenOptix storage phosphor plates (n = 10). Subsequently, the active areas of the plates were placed in a viewing box with a constant light intensity of 1,700 lux for 130 seconds to achieve complete erasing (control plate), as well as for 0, 5, 10, 15, 20, 25, 34, 66, and 98 seconds, to compose the experimental group of partially erased plates. The same exposure settings were repeated using the control and experimental plates, which were scanned at a resolution of 300 dpi. Five radiologists independently examined the pairs of digital radiographs obtained with the control and partially erased plates, in random order, and indicated the best image for oral diagnosis. Cochran-Mantel-Haenszels chi-square test, at a significance level of 5%, was used to compare the percentages of superior quality images in each combination of control and partially erased plates, subjectively assessed. No significant differences were found between radiographic images acquired with control and partially erased plates, except for the combination of 0 second (30%) versus 130 seconds (70%), p = 0.0047. It can be concluded that, under adequate light intensity conditions, erasing intraoral DenOptix storage phosphor plates may require time intervals of as little as 5 seconds.

Image quality in partially erased DenOptix® storage phosphor plates

This study aimed at investigating the effect of the partial erasing of DenOptix® system storage phosphor plates on the image quality of digital radiographs. Standardized digital radiographs were acquired of a phantom mandible, using size 2 intraoral DenOptix® storage phosphor plates (n = 10). Subsequently, the active areas of the plates were placed in a viewing box with a constant light intensity of 1,700 lux for 130 seconds to achieve complete erasing (control plate), as well as for 0, 5, 10, 15, 20, 25, 34, 66, and 98 seconds, to compose the experimental group of partially erased plates. The same exposure settings were repeated using the control and experimental plates, which were scanned at a resolution of 300 dpi. Five radiologists independently examined the pairs of digital radiographs obtained with the control and partially erased plates, in random order, and indicated the best image for oral diagnosis. Cochran-Mantel-Haenszel’s chi-square test, at a significance level of 5 percent, was used to compare the percentages of superior quality images in each combination of control and partially erased plates, subjectively assessed. No significant differences were found between radiographic images acquired with control and partially erased plates, except for the combination of 0 second (30 percent) versus 130 seconds (70 percent), p = 0.0047. It can be concluded that, under adequate light intensity conditions, erasing intraoral DenOptix® storage phosphor plates may require time intervals of as little as 5 seconds.

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.

Effect of introduction of digital radiographic techniques on pre-operative templating in orthopaedic practice.

AIM: To assess whether the introduction of digital radiographic acquisition has altered the magnification of pelvic radiographs compared to standard acquisition techniques, and whether this influences preoperative implant templating for total hip arthroplasty. SETTING: District general hospital orthopaedic out-patient department. PATIENTS AND METHODS: 51 sets of patient radiographs were studied, where digital and standard radiographic techniques had been used for each patient. Key bony landmarks were measured, the scaled ruler analysed and the femur templated to gauge the most appropriate implant size of implant. RESULTS: Introduction of digital techniques has resulted in a mean magnification of 97%, whereas most manufacturers' templates assume a magnification of 115-120%. For the Exeter femoral component, the templated size showed only moderate correlation with that templated from a standard radiograph (kappa index 0.46), although the offset templated showed good correlation (kappa index 0.89). CONCLUSIONS: Surgeons should be aware that introduction of digital techniques of radiograph acquisition may reduce the magnification of the film and, therefore, reduce the accuracy of pre-operative templates supplied by the manufacturers of implants, resulting in incorrect selection of implants.

Comparison of image quality between conventional and low-dose nonenhanced head CT.

BACKGROUND AND PURPOSE: Increasing use of CT for evaluating neurologic disease may expose patients to considerable levels of ionizing radiation. We compared the image quality of low-mAs head CT scans with that of conventional nonenhanced scans. METHODS: Conventional head CT scans were obtained in 20 patients (all >65 years with history of non-CNS malignancy) by using a multidetector technique: 170 mA and 1-second scanning time (ie, 170 mAs), 140 kVp, table speed of 7.5 mm per rotation, pitch of 0.75, section thickness of 5 mm, and field of view of 25 mm. A limited volume helical data acquisition covering four 5-mm-thick images was obtained by using 90 mAs but otherwise the same parameters. Three neuroradiologists visually rated the resulting images for quality in a blinded comparison. Representative 1- to 4-mm(2) regions of interest were chosen in gray matter and white matter locations. Conspicuity and the contrast-to-noise ratio were analyzed. Statistical comparisons were done by using the Student t test. RESULTS: Mean gray matter conspicuity was not significantly different between the 170- and 90-mAs groups (0.39 +/- 0.19 vs 0.41 +/- 0.03, P =.32). Mean gray matter contrast-to-noise ratio was approximately 22% higher with 170 mAs than with 90 mAs (1.77 +/- 0.52 vs 1.39 +/- 0.38, P =.005). All 90-mAs images were rated as having slightly greater image noise than the 170-mAs scans but with sufficient perceived resolution. CONCLUSION: Although 90-mAs head CT images were moderately noisier than 170-mAs images, they were rated as having acceptable diagnostic quality.

[3D automatic expansion: clinical application]. / L'expansion 3D automatique: application clinique.

The determination of the various volumes (GTV: gross target volume, CTV: clinical target volume, PTV: planned target volume) recommended by the ICRU 50 report is a critical step in conformal treatment planning, since treatment optimisation procedures and documentation rely on accurate dose-volume histograms. The shape and the size of the CTV vary with the computer algorithm, the patient image acquisition parameters, the definition of the GTV and the margins surrounding it. The automatic expansion programs included in commercially available treatment planning system require careful validation and control before and during their routine use by the clinicians. Significant differences have been observed between 2D- and 3D-based expansions, with a usual underestimation of the PTV by 2D algorithms.

[Dosimetry and technical quality parameters of the Microfox G-10 medical direct radiographic magnification unit]. / Dosimetrie und technische Qualitätsparameter der medizinischen Direktvergrösserungsradiographieeinrichtung Microfox G-10.

Measurements of the entry dose for four- and eightfold magnifications were carried out in phantoms and patients with the new magnification X-ray-unit Microfox G-10 (fine focus). The skin dose for the fourfold magnification is in the order of conventional radiography, at corresponding voltages. The entry dose for the fourfold magnification of a wrist is about 0.1 cGy (tube voltage 60 kVp, time 0.7 s). In addition measurements were made to determine parameters for quality control. The deviations from the German standards are discussed. Proposals are made how to implement the German Abnahmeprüfung and Konstanzprüfung.

Focal-spot measurement: comparison of slit, pinhole, and star resolution pattern techniques.

The National Electrical Manufacturers Association (NEMA) has established a new standard for x-ray tube focal-spot measurements using a focal-spot camera with a slit instead of a pinhole. Measurements from the slit focal-spot camera are compared and star resolution pattern techniques for 50 focal spots. In addition, measurements were made using direct-exposure film as required by the NEMA standard and an extremity screen-film system, which minimizes x-ray tube loading. The slit, pinhole, and star resolution techniques provided similar results that were within the accuracy required for clinical focal-spot measurements. The focal-spot measurements were also similar when a direct-exposure film or an extremity screen-film system was used. A description of the use of the slit focal-spot camera and difficulties with implementing the new NEMA standards in the clinical setting are also presented.

A comparative evaluation of rare-earth screen-film systems. System speed, contrast, sensitometry, RMS noise, square-wave response function, and contrast-dose-detail analysis.

We evaluated the physical characteristics and contrast-dose-detail performance of 11 rare-earth and three calcium tungstate screen-film systems. Measurements included system speed, contrast, sensitometry, RMS noise, square-wave response function, and contrast-dose-detail analysis. The major differences in physical characteristics among systems were system speed and RMS noise. Square-wave response differences were more subtle. For contrast-dose-detail analysis, the rare-earth screen-film systems and the calcium tungstate system responses were significant over a limited subject contrast range as a function of detail diameter. Relative dose efficiency in the noise-limited region is a function of the properties of the screen only and is independent of the film.

A study of the focal troughs of three panoramic dental x-ray machines. Part I. The area of sharpness.

A comparison of three panoramic x-ray machines revealed that the focal trough of the panorex curved inward in the posterior region, that of the GE-3000 remained straight, and that of the Orthopantomograph flared outward. The panorex was found to have the widest trough in the anterior region; the GE-3000 had the widest trough in the posterior regions.