Purpose: The purpose of this study was to investigate the level of clinical image quality of panoramic radiographs and to analyze the parameters that influence the overall image quality. Materials and Methods: Korean dental clinics were asked to provide three randomly selected panoramic radiographs. An oral and maxillofacial radiology specialist evaluated those images using our self-developed Clinical Image Quality Evaluation Chart. Three evaluators classified the overall image quality of the panoramic radiographs and evaluated the causes of imaging errors. Results: A total of 297 panoramic radiographs were collected from 99 dental hospitals and clinics. The mean of the scores according to the Clinical Image Quality Evaluation Chart was 79.9. In the classification of the overall image quality, 17 images were deemed 'optimal for obtaining diagnostic information,' 153 were 'adequate for diagnosis,' 109 were 'poor but diagnosable,' and nine were 'unrecognizable and too poor for diagnosis'. The results of the analysis of the causes of the errors in all the images are as follows: 139 errors in the positioning, 135 in the processing, 50 from the radiographic unit, and 13 due to anatomic abnormality. Conclusion: Panoramic radiographs taken at local dental clinics generally have a normal or higher-level image quality. Principal factors affecting image quality were positioning of the patient and image density, sharpness, and contrast. Therefore, when images are taken, the patient position should be adjusted with great care. Also, standardizing objective criteria of image density, sharpness, and contrast is required to evaluate image quality effectively.
In diagnostic radiology, the imaging system has been changed from film/screen to digital system. However, the method for removing scatter radiation such as anti-scatter grid has not kept pace with this change. Therefore, authors have devised the indirect flat panel detector (FPD) system with net-like lead in substrate layer which can remove the scattered radiation. In clinical context, there are many radiographic examinations with angulated incident X-ray. However, our proposed FPD has net-like lead foil so the vertical lead foil to the angulate incident X-ray would have bad effect on its performance. In this study, we identified the effect of vertical/horizontal lead foil component on the novel system's performance and improved the structure of novel system for clinical usage with angulated incident X-ray. Grid exposure factor and image contrast were calculated to investigate various structure of novel system using Monte Carlo simulation software when the incident X-ray was tilted ($0^{\circ}$, $15^{\circ}$, and $30^{\circ}$ from the detector plane). More photons were needed to obtain same image quality in the novel system with vertical lead foil only then the system with horizontal lead foil only. An optimal structure of novel system having different heights of its vertical and horizontal lead foil component showed improved performance compared with the novel system in a previous study. Therefore, the novel system will be useful in a clinical context with the angulated incident X-ray if the height and direction of lead foil in the substrate layer are optimized as the condition of conventional radiography.
Purpose : To compare the accuracy of digital subtraction images acquired by two different methods different in positioning four reference points for geometrical standardization. Materials and Methods : A total of 36 digital radiographic images of 6 volunteers were taken at the areas of the incisor, premolar, and molar of both the maxilla and mandible using the Digora system. Each image was moved 4 mm vertically and horizontally. Four oral and maxillofacial radiologists performed digital subtraction radiography between the paired images before and after movement using Emago (Oral Diagnostic Systems, Amsterdam, The Netherlands) and Sunny (Biomedisys Co., Seoul, Korea). The standard deviation of the internal gray value in Region of Interest (ROI) was statistically analyzed between the two programs using the paired t-test. Results : The standard deviation of pixel gray values from the digital subtraction images using the Sunny program were lower than that of the Emago program (p<0.05). All observers showed significant differences between each other when the Sunny program was used (p<0.05), but one observer showed a significantly higher score than other observers when they used Emago (p<0.05). The standard deviations of premolar area from both Sunny and Emago programs were significantly higher than those of anterior and molar regions (p<0.05). Conclusion: The subtracted images using the Sunny program were more accurate and sensitive than those taken using the Emago program.
An 11-year-old, spayed female, weighing 10 kg miniature Schnauzer was admitted for abdominal distension, anorexia, pollakiuria, and constipation. A large, homogeneous fat opacity mass was identified in the retroperitoneum and pelvic cavity on the abdominal survey radiography. The mass displaced the descending colon peripherally and ventrally, and the urinary bladder ventrally. On the abdominal ultrasonographic examination, the mass was uniformly hyperechoic with a coarse internal echo texture and had outer hyperechoic capsule, and it showed homogeneously same attenuation (-180 ~ -110 HU) as adjacent fat on the computed tomography. There was no evidence of invasion into the surrounding structures or organs. Cytological findings from fine needle aspirates were numerous sheets and clusters of adipocytes. The dog showed complete resolution of clinical signs after surgical resection of the mass. The mass was confirmed as simple lipoma through histopathological examination.
A 12-year-old Standard Poodle presented with intermittent weakness and occasional dyspnea at the Veterinary Medicine Teaching Hospital of Kangwon National University. A grade of 4 out of 6 systolic murmur with an irregular tachycardic rhythm was auscultated on both sides of the chest. Systolic blood pressure was 140 mmHg. Panting was noticed in the hospital, but there was no crackle sound. Blood analysis revealed mild increases in liver panel levels (alanine aminotransferase 149 [reference interval, 19-70] U/L; and alkaline phosphatase, 185 [reference interval, 15-127] U/L) and severe increases in cardiac biomarker levels (n-terminal pro-brain natriuretic peptide, 4169 [reference interval, 50-900] pmol/L; and cardiac troponin I, 0.22 [reference interval, 0.03-0.12] ng/mL). On electrocardiography, irregularly irregular supraventricular tachycardic rhythm with an f-wave and no distinct p-wave was observed. Generalized cardiomegaly with an enlarged right atrium and left ventricle was confirmed on thoracic radiography. Moreover, hepatomegaly and an enlarged caudal vena cava were observed. Echocardiographic evaluation revealed a fibromuscular diaphragm in the right ventricle. Because of the obstructive lesion in the right ventricle, the right atrium and ventricle were enlarged (right atrial area index, 38.82 cm2/m2 [reference interval, 4.2-10.2 cm2/m2]; right ventricle end-diastolic area index, 14.152 cm2/m2 [reference interval, 4.9-10.92 cm2/m2]). Accordingly, the patient was diagnosed with double-chambered right ventricle (DCRV). Pimobendan, furosemide, enalapril, diltiazem, and S-adenosylmethionine (SAMe) were prescribed, and all symptoms were relieved. DCRV is a right-sided congenital heart defect resembling pulmonic valve stenosis. If symptoms are not severe, medical therapy can be facilitated without surgery or the balloon dilation.
Purpose: This study compared the diagnostic accuracy of cone-beam computed tomography (CBCT) scans obtained with 2 CBCT systems with high- and low-resolution modes for the detection of root perforations in endodontically treated mandibular molars. Materials and Methods: The root canals of 72 mandibular molars were cleaned and shaped. Perforations measuring 0.2, 0.3, and 0.4 mm in diameter were created at the furcation area of 48 roots, simulating strip perforations, or on the external surfaces of 48 roots, simulating root perforations. Forty-eight roots remained intact(control group). The roots were filled using gutta-percha (Gapadent, Tianjin, China) and AH26 sealer (Dentsply Maillefer, Ballaigues, Switzerland). The CBCT scans were obtained using the NewTom 3G (QR srl, Verona, Italy) and Cranex 3D (Soredex, Helsinki, Finland) CBCT systems in high- and low-resolution modes, and were evaluated by 2 observers. The chi-square test was used to assess the nominal variables. Results: In strip perforations, the accuracies of low- and high-resolution modes were 75% and 83% for NewTom 3G and 67% and 69% for Cranex 3D. In root perforations, the accuracies of low- and high-resolution modes were 79% and 83% for NewTom 3G and was 56% and 73% for Cranex 3D. Conclusion: The accuracy of the 2 CBCT systems was different for the detection of strip and root perforations. The Cranex 3D had non-significantly higher accuracy than the NewTom 3G. In both scanners, the high-resolution mode yielded significantly higher accuracy than the low-resolution mode. The diagnostic accuracy of CBCT scans was not affected by the perforation diameter.
To investigate diagnostic imaging of cystitis and to apply it to the small animal practice, ultrasonogram of urinary bladder with moderate distension(4ml/kg) and with complete distension(9ml/kg) to evaluate the irregularity and thickness of bladder, radiography and histopathological examination were performed after experimental cystitis induction. On double contrast cystography, mucosal membrane of the urinary bladder was smooth and thickening urinary bladder wall was not found before cystitis induction. At 3rd day post induction(PI), mucosal irregularity was noted at the cranioventral region of the urinary bladder. Thickening of the urinary bladder wall and filling defect was observed as well. Cystographic findings of 7, 10, 15, 21 day PI were similar to that of 3rd day PI. On ultrasonographic findings of the mural thickness in induction group, it was ascertain that the mural thickness with moderate distention was more thickened than with complete distention at transverse scan. Ultrasonographic findings at longitudinal scan were similar to those of transverse scan. On ultrasonographic findings of mucosal irregularity in induction group, from PI to 7 day PI, mucosal irregularity with moderate distention was more irregular than mucosal irregularity with complete distention. At 10 day PI, there was similarity between moderate distention and complete distention. On histopathologic examination of a section of urinary bladder taken 3 day PI, the mucosal and submucosa were infiltrated by a mixture of thick inflammatory exudate which was composed of neutrophil, plasma protein, bacterial colony and necrotic cells. Congestion, hemorrhage and edema were also observed in the submucosa. At 7th day PI, the mucosal change was similar to that of 3rd day PI, but neovascularization and fibroplasia were observed in the submucosa. At 15th and 21th day PI, mild hyperplasia of mucosal epithelium was observed in the mucosa. Deposition of collagen, neovascularization and severe diffuse infiltration of lymphocyte were observed. These results suggest that ultrasonographic examination with moderate distention is considered to be a more simple, rapid, noninvasive, sensitive and useful diagnostic method than other diagnostic methods for the diagnosis of the cystitis and the differential diagnosis of urinary tract infection.
Purpose : To acquire the useful diagnostic information through the analysis of the clinical and radiological characteristics of mandibular odontogenic keratocyst. Materials and Methods : The researchers compared and analysed the clinical and radiological features of 112 cases of mandibular odontogenic keratocyst confirmed by histopathlogic examination. Results : Mandibular odontogenic keratocysts occurred more frequently in males than in females and the incidence is the highest in the 2nd and 3rd decades. These cysts occurred in the mandibular posterior area, angle-ramus area and anterior area $51.8\%$, $31.2\%$ and $17.0\%$ respectively. These cysts had undulating border ($69.6\%$) rather than smooth border ($30.4\%$). Most of these cysts had well-defined hyperostotic border ($94.6\%$). These cysts caused cortical thinning or expansion ($78.6\%$) rather than no cortical reaction ($21.4\%$). Loss of lamina dura was observed in $72.3\%$, displacement of tooth appeared in $35.7\%$ and root resolution appeared in $12.5\%$ of cases. In $71\%$ of cases, displacement of mandibular canal was observed. Internal patterns of lesional radiolucency were even ($61.6\%$) or uneven ($38.4\%$). Conclusion : These results would be helpful in diagnosing of mandibular odontogenic keratocyst. (Korean J Oral Maxillofac Radiol 2005; 35 : 51-4)
Currently, many hospitals are hastening to introduce digital radiography systems. This is a direct result of the intentions to improve medical services and to digitalize radiology information systems, and is also leading to the improvement of medical imaging technology. Throughout F/S system's long history, many people have researched the image quality and dosage concerning these systems, and as a result, huge improvements in the dosage of patients were possible. Similarly, I believe that DR systems need the same kind of effort. Of course, decreases in dosage that ignore image quality are unthinkable. The results of experiments conducted by five hospitals during a period of 3 months brought to us the conclusions listed below. 1. Based on the comparison and analysis of the exposure control of F/S systems and DR systems, DR systems generally showed higher exposure control for parts of the phantom that became thicker, and the exposure control improved rapidly as the thickness increased. 2. DR systems still proved to be somewhat deficient in resolution measurements compared to existing F/S systems. The image processing part of DR systems contributed much to these result. 3. Under conditions used clinically, the dosage measurements of DR systems were generally higher regardless of region. 4. According to the evaluation of image quality, DR systems showed a higher degree of satisfaction as the thickness of the region became thinner. As mentioned above and based on the mutual relationship experiments between the dosage and image quality of F/S systems and DR systems, research to increase the satisfaction of DR systems must be considered.
An 8 month old female Maltese (body weight 3.6 kg) was referred with primary complaints of dyspnea and exercise intolerance. Diagnostic imaging studies revealed marked cardiomegaly and prominent main pulmonary trunk dilation on thoracic radiography, abnormally arisen aortic roots (toward right ventricle) with left-to right shunted perimembraneous ventricular septal defect located underneath of aortic root, aortic root was located to predominantly to the right ventricle and pulmonary regurgitation (peak velocity 4.7 m/s, pressure gradient ~88 mmHg) from pulmonary over-circulation and hypertension on echocardiography, indicating double outlet right ventricle (DORV). The dog was treated with furosemide (1 mg/kg, BID) for reducing volume overload at right ventricle, spironolatcone (1 mg/kg) and enalapril (0.5 mg/kg) for minimizing deleterious cardiac remodeling, and sildenafil (1 mg/kg) for lessening pulmonary over-circulation and hypertension. The clinical condition of this dog was improved after 1 week of medical treatment. The dog is currently survived and regularly monitored.
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