产前三维超声诊断及评价胎儿半椎体

目的 探讨三维超声诊断胎儿半椎体及所致脊柱侧弯的价值。方法 对中晚期妊娠正常胎儿30胎及9胎二维超声疑诊半椎体胎儿进行三维超声检查,与X线片及引产后数据进行对照。结果 三维超声对30胎正常胎儿脊柱冠状面的显示率为100%（30/30）, 二维超声仅为30.00%（9/30）。9胎疑诊半椎体胎儿中,7胎为半椎体,2胎为蝴蝶椎、半椎体混合畸形。对超声发现的8胎脊柱侧弯胎儿测量Cobb角,与X线测量结果差异无统计学意义（t=0.11,P=0.91）。结论 三维超声有助于诊断及评价胎儿半椎体,可为产前评估胎儿半椎体和判断预后提供更多信息。     

基于双能X线吸收测量法的三种胫骨软骨下骨骨密度测量方法的信度与效度分析

目的 观察基于双能X线吸收测量法(DXA)的三种胫骨近端软骨下骨骨密度检测方法的信度与效度。方法 招募28名健康女性,利用双能X线骨密度仪扫描膝关节;由2名研究者分别应用三种不同测量方法选取ROI进行测量分析,通过计算组内相关系数值(ICC),评价各方法的复测信度与测量者间信度,利用t检验评价区分效度。结果 三种方法均具有较好的复测信度(ICC 0.833~0.998)与测量者间信度(ICC 0.905~0.997),且对低年龄者和高年龄者具有较好的区分效度(P<0.05)。结论 利用双能X线骨密度仪研究膝关节软骨下骨具有可行性;本研究分析的三种测量方法可有选择地用于临床研究。     

三维经食管超声心动图与其他影像技术指导左心耳封堵术的对比

目的 探讨三维经食管超声心动图（3D-TEE）和2D-TEE、CTA和术中X线造影在左心耳（LAA）形态、大小评估及指导封堵器型号选择方面的价值。方法 对43例拟行LAA封堵术的心房颤动患者行TEE,清晰显示LAA并于0°、45°、90°和135°分别测量其开口最大径和最大深度值;于LAA显示最清晰切面启动3D-ROOM模式测量开口最大径、最小径,并将其与2D-TEE、CTA和X线造影的检查结果进行对比。结果 3D-TEE测量LAA开口最大径与2D-TEE、术中X线造影测值差异无统计学意义（P均>0.05）,CTA测量LAA开口最大径明显大于3D-TEE、2D-TEE和X线造影测值（P<0.01）;2D-TEE于90°和135°测量LAA最大深度值与CTA测值差异有统计学意义（P均<0.05）,与术中X线造影比较,仅在135°时差异有统计学意义（P<0.01）。3D-TEE测量LAA开口最大径与2D-TEE各角度、CTA和X线造影测值呈明显正相关（r=0.70~0.77、0.57、0.58,P均<0.01）;2D-TEE各角度测量LAA开口最大径与CTA、X线造影测值均存在相关性（r=0.57~0.71,0.45~0.51;P均<0.01）;3D-TEE、2D-TEE、CTA及X线造影LAA开口最大径与封堵器大小均呈明显正相关且（r=0.93、0.70~0.77、0.57、0.47,P均<0.01）。结论 3D-TEE与2D-TEE、CTA和X线造影相比,3D-TEE对于封堵器大小的选择更具指导性。     

乳腺X射线摄影及MRI评估伴微钙化乳腺癌新辅助治疗后残余病灶

目的 观察乳腺X射线摄影（MG）及MRI评估伴微钙化乳腺癌新辅助治疗（NAT）后残余病灶的效能。方法 回顾性分析145例经手术病理证实伴微钙化的乳腺癌患者,均接受NAT及NAT前、后MG及乳腺MR检查,测量X线片中钙化最大径及增强MRI所示病灶强化最大径,评估NAT后X线片所示钙化范围变化,并记录病理所见残余肿瘤大小及完全缓解（pCR）等。观察NAT后X线片所见残余钙化范围最大径及增强MRI残余肿瘤强化灶大小与病理残余肿瘤大小的相关性,分析X线片钙化范围变化与pCR的相关性。以病理结果为标准,计算MRI评估残余肿瘤pCR的敏感度、特异度、假阳性率及假阴性率。结果 145例中,144例浸润性癌,1例导管原位癌;NAT后67例达pCR。NAT后X线片所示钙化范围最大径与病理残余肿瘤大小无明显相关（P=0.49）,增强MRI残余肿瘤强化灶大小与病理残余肿瘤大小呈中等相关（r=0.69,P<0.01）。NAT后钙化范围52例不变、65例缩小、28例增加,其间pCR差异无统计学意义（χ²=1.79,P=0.44）。MRI评估残余肿瘤pCR的敏感度为93.59%（73/78）,特异度为62.69%（42/67）,假阳性率37.31%（25/67）,假阴性6.41%（5/78）。结论 NAT后X线片所示乳腺癌残余钙化最大径与病理残余肿瘤大小之间无明显相关;MRI残余病灶大小与病理残余肿瘤大小呈中度相关,且以之评估残余肿瘤达pCR与否的效能较佳。     

基于深度学习构建模型识别下肢全长正位X线片中的下肢力线关键点及自动测量关键角度

目的 基于深度学习（DL）方法构建自动测量下肢全长正位X线片关键角度模型,评估其临床应用价值。方法 回顾性选取634幅下肢全长正位X线片,由5名骨科医师分别标注下肢力线关键点,包括髋关节中心、股骨髁间窝顶点、胫骨髁间嵴中点、股骨内侧和外侧髁最低点、胫骨内侧和外侧平台最低点、距骨宽度中点,并建立数据集。采用高分辨率网络（HRNet）进行迁移学习,构建自动检测关键点模型,以5折交叉验证筛选最优模型,确定关键点坐标后,通过余弦定律计算关键角度机械股骨远端外侧角（mLDFA）、胫骨近端内侧角（MPTA）、股骨胫骨关节线夹角（JLCA）及髋-膝-踝角（HKA）,实现自动测量关键角度,并以关键点自动检测模型和通过余弦定律计算所得关键角度共同构建自动测量关键角度模型。随机选取50幅图像,由另3名骨科医师手动测量上述关键角度,评估自动测量关键角度模型与医师测量结果的一致性。结果 3名骨科医师所测mLDFA、MPTA、JLCA及HKA的均值分别为（88.50±2.59）°、（86.41±2.25）°、（2.90±2.27）°及（174.62±3.97）°;自动测量关键角度模型所获结果分别为（88.48±2.60）°、（86.52±2.57）°、（3.11±2.41）°及（174.53±3.99）°,与医师测量结果的一致性较好（ICC=0.897、0.888、0.826、0.996）。结论 所构建的自动测量下肢全长正位X线片关键角度模型有助于识别骨科关键点和测量关键角度。     

双能CT评估骨密度

目的 评价利用双能CT（DECT）测量容积CT值评估骨密度（BMD）的可行性。方法 对11名志愿者采用双能X线吸收法（DXA）测量腰椎（L1~L4）及股骨（股骨颈）BMD值;并对所有研究对象进行DECT检查,获得钙值图,测量容积CT值,分析容积CT值与BMD值的相关性。结果 腰椎容积CT值与BMD值呈显著正相关（r=0.82,P<0.001;相关函数为Y=0.004X-0.879,其中Y为BMD值,X为容积CT值）;股骨容积CT值与DXA所测BMD值无明显相关性（P>0.05）。结论 DECT所测腰椎容积CT值与DXA所测BMD值密切相关,可定量反映腰椎BMD变化。     

乳腺导管原位癌的诊断:超声与数字钼靶X线摄影对照

目的 探讨超声与数字钼靶X线摄影及两者联合对不同级别乳腺导管原位癌(DCIS)的诊断价值。 方法 收集我院经手术病理确诊的DCIS患者38例,比较超声与数字钼靶X线摄影及两者联合对不同级别DCIS的诊断符合率及微钙化特征。 结果 高级别DCIS 20例,低级别和中级别DCIS 18例;单纯DCIS 28例,DCIS伴微浸润10例。超声对DCIS、高级别DCIS、低级别和中级别DCIS诊断符合率分别为73.68%(28/38)、90.00%(18/20)和55.56%(10/18)。数字钼靶X线摄影对DCIS、高级别DCIS、低级别和中级别DCIS诊断符合率分别为76.32%(29/38)、90.00%(18/20)、61.11%(11/18)。两者联合对DCIS、高级别DCIS、低级别和中级别DCIS诊断符合率分别为78.95%(30/38)、90.00%(18/20)、66.67%(12/18)。超声与数字钼靶X线摄影对DCIS的微钙化检出率均为57.89%(22/38)。 结论 超声与数字钼靶X线摄影对DCIS的诊断符合率与微钙化发现率相似,直径>20 mm的DCIS常伴有微浸润,直径<10 mm无钙化的DCIS易于漏误诊。     

甲型H1N1流感肺炎影像学表现

目的 总结甲型H1N1流感肺炎影像学表现,提高对本病的认识。方法 回顾性分析17例确诊甲型H1N1流感肺炎患者胸部X线片及64层螺旋CT检查系列影像学资料。结果 17例甲型H1N1流感肺炎患者均有1次以上胸部计算机X线摄影术(CR)检查,其中8例接受CT检查。17例胸部X线及CT表现均以斑片或大片实变影合并磨玻璃密度影为主要表现。病变累及单侧肺野者4例,占23.53%;双侧肺野均受累者13例,占76.47%;随访病例均有不同程度的纤维化改变。结论 甲型H1N1流感肺炎X线及CT表现具有一定特征性。肺部病变以多叶段分布渗出性改变为其共有表现,病程后期两肺以纤维化表现为主。     

基于磁化率成像Brainnetome Atlas脑网络组图谱定量分析脑铁的可行性

目的 探讨基于定量磁化率成像（QSM）脑网络组图谱定量分析脑铁的可行性。方法 将43名右利手健康成年志愿者的QSM图像通过Matlab软件配准及滑处理对应到标准脑，在Brainnetome Atlas脑网络组图谱上选择双侧苍白球、壳核、尾状核、海马、丘脑、额叶、顶叶及枕叶皮质ROI，以Matlab软件测量磁化率值，并对上述脑区手工勾画ROI，测量磁化率值。对软件及手工所测磁化率值与尸检脑组织染色所得铁浓度结果进行相关分析，观察其与年龄的相关性，比较不同性别、侧别间磁敏感值差异。结果 Matlab软件和手工测量磁化率值均以苍白球最高，壳核次之，海马最低；2种方法所测磁化率值均与尸检铁浓度结果呈正相关（r=0.920、0.856，P=0.003、0.014）。Matlab法测得男性额叶皮质磁化率值高于女性（P<0.05），其余部位无显著性别差异（P均>0.05）；2种方法所测磁化率值均无显著侧别差异（P均>0.05）。结论 基于QSM成像Brainnetome Atlas脑网络组图谱脑铁定量方法测量脑铁含量具有较高准确性及可行性；脑铁含量随年龄而增加，额叶皮质铁含量存在性别差异。     

定量CT和双能X线吸收评价北京地区老年人股骨近端骨结构的比较

目的 分析定量CT(QCT)和双能X线吸收(DXA)对股骨近端髋部结构分析(HSA)结果的相关性。方法 对北京地区40名男性(53~76岁)和76名女性(48~76岁)社区居民行左髋DXA和QCT扫描,分别测量股骨颈横截面积(CSA)和横截面转动惯量(CSMI),对两种方法测量结果行Spearman相关性分析。结果 QCT所测CSA和CSMI均大于DXA所测CSA和CSMI(P均<0.01),两种方法测量CSA差值的中位数为0.97 cm²,CSMI差值的中位数为0.49 cm⁴。QCT和DXA测量CSA和CSMI均显著相关(r=0.85、0.78,P均<0.01)。结论 DXA和QCT对中国老年人股骨颈CSA和CSMI测量具有较高的相关性,可用于老年人群股骨近段骨结构诊断。     

数字化双能量减影技术评价正常人肺纹理的价值

目的 评价双能量减影和常规数字化摄影两种方法显示正常人肺纹理的价值,旨在为应用双能量减影技术进一步研究肺内疾病提供一定的理论基础.方法 本组30例患者分别摄取常规数字化胸片、双能量减影软组织胸片共60张.4位高年资放射医师独立阅片后,评价上述方法显示相应区域肺纹理的优劣.结果 经过统计学分析,在双侧肺野的8个区域内,双能量减影软组织胸片对肺纹理的显示优于常规数字化胸片(P值均＜0.05).结论 在双侧肺野中软组织重叠少、伪影小的区域,胸部双能量减影软组织成像对肺纹理的显示优于常规数字化胸片.     

Dosimetric and Contrast Noise Ratio Comparison of Three Different Digital Imaging Technologies in Mammography

PurposeThe purpose of the study was to compare the three most common technologies available in digital mammography based in the evaluation of average glandular dose and contrast noise ratio (CNR).MethodThe average glandular dose was estimated with a direct digital detector (aSe) with a pixel size of 0.85 μm, a photon counter with a pixel size of 50 μm and a computerized radiography (CR) system. A semiconductor detector was used to measure the input kerma to the detector, and the average glandular dose was calculated from the conversion factors dependent on the anode filter combination, half value layer and breast glandularity.ResultsThe average glandular dose obtained with polymethyl methacrylate and CNR of mean thickness 4.5 cm using direct digital equipment was 1.02 mGy and CNR = 7.4; using the photon counter it was 0.43 mGy and CNR = 4.7 in C100 mode, and 0.64 mGy and CNR = 5.7 in C120 mode; and using the photostimulable CR, the estimated value was 1.65 mGy and CNR = 5.1.ConclusionsThe photon counter offers a lower average glandular dose than the other two devices with adequate image quality (CNR). The CR equipment offers a similar CNR value but delivers a higher dose than the new generations of available mammograms.     

Key Performance Indicators for Comparing the Performance of Portable Radiography: Direct Digital Radiography versus Conventional Machine Computed Radiography—A Study in a Nonacute Hospital

IntroductionPortable radiography traditionally has been performed with a conventional portable x-ray unit with computed radiography (CR) system (conventional-CR combo), and off-site processing of the exposed CR cassettes was time-consuming. The direct digital radiography (DDR) portable x-ray system, with the digital image immediately available for review and wireless transmission as the key merits, is newly installed for portable radiography. Thus, the work flow of portable radiography is changed. This study was performed to quantitatively investigate the performance of portable radiography using the DDR portable x-ray system and conventional-CR combo in terms of efficiency and work flow enhancement.MethodsOne hundred ninety portable x-ray examinations were timed for each procedural step using conventional-CR combo (n=97) and the DDR portable x-ray system. The following key performance indicators were designed for measuring the performance of portable radiography quantitatively: “examination duration,” “time for image becoming available in PACS,” “postacquisition processing time,” and “manpower deployment time.”ResultsProductivity was raised by 96% using the DDR portable x-ray system. “Examination duration” using the DDR portable system was significantly faster (P < .0001), with a mean calculated time of 13.4 ± 7.6 minutes for the DDR portable system and 25.2 ± 10.9 minutes for conventional-CR combo. The “time for image becoming available in PACS” was significantly shorter than that of conventional-CR combo (P < .0001), with a mean time of 6.8 ± 2.6 minutes for the DDR portable system and 19.2 ± 9.7 minutes for conventional-CR combo. The “postacquisition processing time” was measured with slight differences, with a mean time of 2.2 ± 1.1 minutes for the DDR portable system and 1.9 ± 1.0 minutes for conventional-CR combo (P = .1064). Because more portable x-ray examinations could be performed when using the DDR portable x-ray system in each round of service, the mean “manpower deployment time” when using the DDR portable x-ray system was longer (ie, 82.6 ± 46.8 minutes for the DDR portable system and 24.5 ± 11.9 minutes for conventional-CR combo).ConclusionsBy using the new DDR portable x-ray system with work flow changes, the performance of portable radiography was improved in efficiency and work flow was enhanced. Furthermore, the four defined key performance indicators in this study may help provide a framework for measuring the performance of portable radiography in other institutions.     

全数字化乳腺点压摄影诊断致密型乳腺中乳腺癌

目的 探讨数字化乳腺点压摄影对致密型乳腺的乳腺癌的诊断价值。 方法 对68例致密型乳腺的乳腺癌患者经全数字化乳腺X线检查常规检查(首尾位及内外斜位)后,对触诊异常区域加摄无放大点压摄影,分别分析常规摄影和点压摄影的影像表现并进行对比。 结果 点压摄影在肿块显示、毛刺显示方面明显优于常规摄影。两种方法对钙化的显示率无显著差别,但在显示钙化数量、大小、形态及密度等具体特征方面,压点摄影优于常规摄影。4例常规摄影显示乳腺结构扭曲的患者,点压摄影可见小肿块;5例常规摄影显示乳腺局灶性不对称患者,点压摄影均可见肿块。点压摄影的诊断准确率(86.76%)高于常规摄影(63.24%),漏诊及误诊率(4.41%)低于常规摄影(14.70%)。 结论 常规乳腺摄影结合点压摄影能够明显提高致密型乳腺的乳腺癌的诊断准确率。     

Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients

IntroductionUltrasound of the lung and quantification of B lines was recently introduced as a novel tool to detect overhydration. In the present study, we aimed to evaluate a four-region protocol of lung ultrasound to determine the pulmonary fluid status in ventilated patients in the intensive care unit.MethodsFifty patients underwent both lung ultrasound and transpulmonary thermodilution measurement with the PiCCO system. An ultrasound score based on number of single and confluent B lines per intercostal space was used to quantify pulmonary overhydration. To check for reproducibility, two different intensivists who were blinded as to the ultrasound pictures reassessed and classified them using the same scoring system. The results were compared with those obtained using other methods of evaluating hydration status, including extravascular lung water index (EVLWI) and intrathoracic blood volume index calculated with data from transpulmonary thermodilution measurements. Moreover, chest radiographs were assessed regarding signs of pulmonary overhydration and categorized based on a numeric rating scale.ResultsLung water assessment by ultrasound using a simplified protocol showed excellent correlation with EVLWI over a broad range of lung hydration grades and ventilator settings. Correlation of chest radiography and EVLWI was less accurate. No correlation whatsoever was found with central venous pressure measurement.ConclusionLung ultrasound is a useful, non-invasive tool in predicting hydration status in mechanically ventilated patients. The four-region protocol that we used is time-saving, correlates well with transpulmonary thermodilution measurements and performs markedly better than chest radiography.     

Diagnostic radiography students' experiences of a practical method demonstrating the effect of milliampere-second in digital X-ray imaging systems

BackgroundThe effect of exposure technique factors varies between analogue and digital X-ray imaging systems (DR). Understanding these variations is paramount to optimising radiation protection, yet radiographers are unclear about these effects. A practical method to demonstrate milliampere second (mAs) effect in DR was developed to assist diagnostic radiography students in understanding exposure technique factors in DR.ObjectivesTo explore second-year diagnostic radiography students' experiences of a practical method to demonstrate the effect of mAs in DR.MethodsA qualitative research approach employing an open-ended questionnaire explored second-year diagnostic radiography students' experiences of the practical method demonstrating the effect of mAs in DR. Twenty students participated in the study, and the data collected underwent thematic analysis.ResultsStudents appreciated working in small groups and provided suggestions to improve the practical method's instruction sheet. Most students' predicted outcome differed from the actual outcome of the demonstration. Seeing and documenting the effect of mAs in DR not only enhanced students' understanding of it but showed the implications of increasing mAs on image quality and radiation exposure.ConclusionStudents found that the practical method enhanced their understanding of mAs and exposure technique factors in DR. Additionally, the practical method highlighted exposure creep in DR and radiographers' role in protecting patients from overexposure to ionising radiation in the digital era.     

Heel pad thickness: determination by high-resolution ultrasonography

Heel pad thickness classically is increased in acromegaly and can also be noted in long-term Dilantin therapy. A high-resolution 10-MHz dedicated superficial small parts real-time scanner was used to evaluate heel pad thickness without the use of radiation and without the magnification inherent in the standard procedure, a lateral radiograph of the foot. Fifty-four patients were studied, and it was determined in 10 controls that heel pad thickness averaged 16.6 mm. In 38 diabetics without ulcers of the feet, the heel pad was 17.8 mm. A single treated acromegalic had a heel pad thickness of 21 mm. Ultrasonography offers an effective alternative to radiography in the measurement of heel pad thickness.     

The Use of Digital Side Markers (DSMs) and Cropping in Digital Radiography

IntroductionThis article explores two phenomena in the general radiography environment—the increasing use of digital side markers (DSMs) by radiographers and the possibility for radiographers to “crop” radiographs post-exposure. This article offers originality by identifying the rationales of radiographers when using digital equipment.MethodsThis study formed part of a larger ethnographic study undertaken in the United Kingdom (UK). Participant observation and semi-structured interviews were used. Overt participant observation identified cropping and DSM placement within the X-ray room. Semi-structured interviews later supported and/or refuted the rationale for DSMs and cropping clinically.ResultsTwo themes are discussed. First, radiographers support the use of DSMs by suggesting that mistakes will happen regardless of using an ASM and/or DSM. Furthermore, it is proposed that ASMs and DSMs can be interchangeably used in practice. Second, radiographers acknowledge the use of cropping ensuring their radiographs resemble “a textbook image.” This leads to question the optimum use of collimation in the clinical environment and how it may go unnoticed.ConclusionThis article concludes by recognizing some challenges digital radiography currently provides. The rationale and continuing use of DSMs and cropping of radiographs by radiographers highlights alternate complexities with digital technology in the clinical environment and how we may best overcome such challenges that influence the profession.     

Measurement properties of a hand-held inclinometer during straight leg raise neurodynamic testing

ObjectivesThe most common lower quarter neurodynamic test is the straight leg raise (SLR) test. Quantification of limb motion during SLR testing should utilize reliable and valid measurement tools that are highly sensitive to change. The purpose of this study was to determine the psychometric properties of a hand-held inclinometer commonly utilized during SLR testing.DesignCross-sectional measurement, intra-rater reliability and validity study.SettingResearch laboratory.ParticipantsTwenty individuals without pain in their low back or extremities and no history of nerve injury participated in the study.Main outcome measuresTwo repetitions of the SLR were performed in each limb in two ankle positions (plantar flexion and dorsiflexion). A digital inclinometer and digital goniometer were utilized as the comparisons for range of motion measurements.ResultsIntra-rater reliability for the hand-held inclinometer during SLR testing was excellent (ICCs, 0.95 to 0.98). The standard error of measurement was between 0.54° and 1.22° and the minimal detectable change was between 1.50° and 3.41°. Construct validity revealed hand-held inclinometer measurements were highly correlated with both the digital inclinometer and digital goniometer measures. The mean difference scores between hand-held inclinometer and digital inclinometer (～1.5°) and digital goniometer (～10°) suggest that the hand-held inclinometer better matches the construct measured by the digital inclinometer (limb elevation angle) compared to the digital goniometer (hip flexion angle).ConclusionsThe hand-held inclinometer is a valid method for measuring limb elevation angle during the SLR neurodynamic test in a research setting. The hand-held inclinometer has high reliability and low minimal detectable change when used in healthy individuals.     

移动DR后处理参数对床旁胸片影像质量的影响

目的 探讨移动数字化X摄影（DR）不同后处理参数对床旁胸片影像质量的影响。方法 对150幅床旁胸片图像进行多频拉普拉斯变换（MLT）、图像处理（IP）等后处理参数调整,分析总结后处理参数的优化方案。测量肺部相关区域光学密度值,以配对样本t检验比较出厂设置默认参数与后处理参数优化肺部相关区域光学密度值的差异和图像质量评分的差异。结果 亮度、对比度以及动态范围中的低密度参数对床旁胸片图像质量影响较大。调整并优化后处理参数后,胸部第2肋间区域密度值为1.68±0.04,肺门密度值为0.77±0.46,肺周边部密度（近胸壁1 cm处与单肋骨重叠处）值为0.62±0.06,心影密度值为0.44±0.04,膈下密度值为0.37±0.04,两肺野外带纹理清晰显示,脊柱和心影后区肺纹理可见,符合诊断学要求。第2肋间、肺门、肺周边部、心影部、膈下部均为调整前密度值小于调整后密度值,差异有统计学意义,且调整后的密度值均较调整前接近参考密度值;优化后处理参数后所得影像质量评分为（3.53±0.14）分,高于优化前（3.02±0.23）分,差异有统计学意义。结论 适合的后处理参数值是保证移动DR床旁胸片肺部各区域合理密度值的关键,优化后处理参数可提高移动DR床旁胸片的影像质量。