计算机X线摄影系统在床边胸部X线摄影中的应用价值

目的　通过对CR系统在床边胸部X线摄影中若干技术要素的研究 ,提高床边X线胸片质量。方法　①设置最佳的床边胸部曝光条件表和影像后处理技术参数表 ;②运用影像工作站窗宽 (s shift)、窗位 (c shift)实施对影像密度和对比度的调节。③运用谐调处理和空间频率处理技术实施影像细节的调节。结果　易于给定曝光条件 ,曝光剂量减少了18% ,10 0 %地保证了胸片的质量 ,废片率为零。结论　掌握好床边X线摄影和CR系统各项技术 ,有助于提高图像质量和胸部病变的检出率     

DR胸部摄影影像处理参数的探讨

目的探讨数字化胸部摄影(DR)影像处理,包括边缘、窗技术、组织均衡等参数的合理的选择和运用,以提高胸部摄影的图像质量.方法对30例患者的DR胸部摄影图像进行后处理,并对影像处理参数修改前后照片进行对比分析,确定最佳的胸部影像处理参数.结果 DR胸部摄影处理参为Edge=2;Brightness=157;Contrast=108;Area=0.5;Strength=0.3.结论 DR胸部摄影比常规胶片摄影的动态范围更宽,这意味着DR图像的最高和最暗区域之间有更多的层次,也意味着X光成像能够更好地确定密度变化,合理的选择影像处理参数可获优质图像,并提高最终的诊断质量.     

胸部DR成像500例分析

目的：探讨DR成像在胸部X线检查中的临床应用价值。方法：500例胸部DR成像,应用后处理技术分别调整图像的密度和对比度、图像黑白反转对比,并实施影像的局部放大、细节增强等。结果：胸部DR能清楚显示病变,全面保证了照片质量,甲片率为95％,废片率为0。结论：DR胸部成像弥补了常规X线片的不足,提高了照片质量,有较大的临床应用价值和广泛前景。     

计算机X线摄影与传统X线摄影用于床边胸部摄影的效果比较

目的比较计算机X线摄影（computed radiography,CR）与传统X线摄影在床边胸部摄影中的效果。方法280例受行床边胸部摄影患者随机分为A组120例和B组160例。A组采用传统X线床边胸部摄影,B组采用CR床边胸部摄影。分析CR与传统X线摄影床边胸片的影像质量,统计床边胸片的甲级片率、乙级片率及废片率。结果B组甲级片率、乙级片率均明显优于A组（P均〈0.01）。结论CR能提高床边胸片影像质量,减少X线射线量,降低废片率。     

计算机X线摄影(CR)在新生儿床旁片的临床应用

目的探讨计算机X线摄影(CR)在床旁新生儿各部位X线摄影、尤其是新生儿胸部摄影的临床应用价值。方法选取100份床旁CR片,利用曝光条件的宽容度,设置最佳参数,综合运用计算机图像后处理和空间处理技术等,对影像细节进行调节,并与传统X线摄影片进行对比分析。结果CR照片对比度良好,层次清晰度高,摄影失真度小,废片率为1%,普通片为9%。结论CR在床旁新生儿各部位X线摄影,新生儿胸部摄影时,有助于提高图像质量和病变的检出率。     

CR影像噪声特点分析

目的：探讨计算机X线摄影（Computed Radiography,CR）影像噪声的特点,找出降低CR影像噪声的方法,以提高CR影像质量。材料与方法：以10mAS、20mAS、40mAS为固定X线量档,从50至150kV、步长为2kV对实验猪胸部进行系列曝光,用ADCCOMPACTPLUSCR阅读器读IP,将所获得的CR影像经后处理后保存及打印出照片。结果：曝光条件不足的影像噪声明显增加,曝光条件过高的影像黑化度增加,后处理无法调节。IP久置不用不经刷新就直接使用会导致影像噪声增高。结论：CR动态范围就比屏片系统大得多,曝光宽容度就大得多,而且具有后处理功能,一张适当黑化度的图像,不全由曝光条件控制,而是由后处理就可以得到,在很大的范围内,CR随意取任何曝光条件,CR照片影像噪声因素是多方面的,摄影中,在未超出机器负荷情况下,尽量使用小焦点、小照射野,根据患者病变部位、大小、密度、体厚、距离等因素选择合适的曝光条件,根据摄影部位大小选择合适规格的IP,加强后处理的管理,熟练掌握后处理的各项技术,定期清理IP板表面,保持良好的工作环境,对于减少噪声的产生,降低噪声对X片的影响是十分重要的。     

控制CR影像质量探讨

我院2004年4月开始应用计算机X线摄影（CR），作为传统X线摄影向直接数字化摄影的过渡，推进了X线摄影系统的数字化。如何保证和提高CR的影像质量，必须充分考虑IP板、曝光量、图像后处理、干式激光打印机等诸多影响影像质量的环节，才能保证和提高CR的影像质量。     

数字化X线机胸部描准照片摄影技术的临床应用

目的 探讨数字化X线机胸部描准照片摄影技术质量控制(Qc)的最佳方法。方法 对38例胸部瞄准照片进行了效果分析。就照片中肺尖、外带肺纹理、肋骨重叠的肺纹理、肺的血管、空洞液平面等阴影的显示几率、照片层次等作一评价。结果 由于Qc的较好实施，提高了胸部瞄准照片的质量。结论 用数字化X线机摄影技术做胸部描准照片对于早期发现肺肿瘤、转移性结节、肺结核及其他弥漫性病变有着极其重要的意义。     

传统胸部X线摄影

１引言在临床实践中,判读胸部Ｘ线照片大约８０％应与先前的Ｘ线检查相对照,对照判读可帮助放射学家识别异常并确定它们的临床意义。然而,常常由于影像质量致使对照成为困难,为此,人们在传统Ｘ线摄影技术上做了大量工作。近年来,许多作者发表了数字胸部Ｘ线摄影影像...     

直接数字化摄影技术（DR）与传统高仟伏摄影（HKV）在尘肺检查中的应用分析与探讨

目的探讨直接数字化摄影技术（DR）与传统高仟伏摄影（HKV）在尘肺检查中的应用价值及各自优势。方法通过对150例粉尘作业患者的直接数字化摄影（DR）胸片和传统高仟伏摄影（HKV）胸片进行对比分析,找出两组方法在图像质量上存在的差异。结果胸部DR片和传统高仟伏摄影（HKV）胸片质量优片率分别为77％和52％,优片率经χ2检验,P〈0．05差异有统计学意义。对肺部细微结构总体显示率分别为100％和73％,总体显示率经χ2检验,P〈0．01差异有非常显著性意义。结论直接数字化摄影技术（DR）能提供更好的影像质量,提高诊断的正确率,以更清晰地显示和发现肺部病变,在尘肺诊断中提供更大的应用价值,有效保障劳动者权益。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.