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INTRODUCTION: Image reject analysis (RA) in direct digital radiography (DDR) is an important quality indicator tool. Analysis of rejected images is a component of quality assurance (QA) programmes, with the overall aim of reducing patient radiation dose. This study aimed to compare differences in image rejection rates (RR) and the reasons for rejection between two radiology departments. METHODS: A retrospective quantitative descriptive study of images performed across the two radiology departments (RAD 1 and RAD 2) acquired with DDR systems between the beginning of February and the end of May 2021 was undertaken. Collected data included the medical imaging technologist (MIT) selection of image rejection reasons for different anatomic regions and compared between the two radiology departments. RESULTS: A total of 47,046 images and 29,279 images were acquired at RAD 1 and RAD 2, respectively, with an overall image rejection rate of 7.86% at RAD 1 and 5.91% at RAD 2. The primary reason for image rejections was positioning errors, 79.4% and 77.3% recorded at RAD 1 and RAD 2, respectively. Significant differences were demonstrated between the two radiology departments for image rejection rates and selected reasons for rejection for most anatomical body groups. CONCLUSION: The implementation of image RA remains a key part of QA in radiology departments utilising DDR systems. This study recommends interventions based on image RRs for examinations taking into consideration the department-specific variations and imaging protocols used.

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OBJECTIVES: To evaluate and compare the accuracy of Direct Digital Radiography (DDR) and cone-beam computed tomography (CBCT) in determination and diagnosis of periodontal osseous defects. METHODS: A nonrandomized in vivo study was conducted to compare the two imaging modalities, DDR and CBCT, for the diagnosis of periodontal osseous defects. Comparison was made between the linear measurements of DDR and CBCT images with the actual measurements of various osseous defects during surgical exposure (Gold standard). RESULTS: The results of the present study demonstrated the difference in the mean values of the DDR and surgical exposure measurements of periodontal osseous defects, whereas comparable mean values were found between the CBCT and surgical exposure measurements, with no statistically significant difference (P > 0.05) being found between each modality. CONCLUSION: CBCT proved to be an indispensable imaging tool in detecting and quantifying periodontal defects and furcation involvement more precisely and could provide additional benefits over the traditional radiography for clinical and postsurgical evaluation.

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Rationale and objectives: We aimed to report and compare accuracy, reproducibility, and reporting confidence between thoracic dual-energy subtraction (DES) and routine posterior-anterior chest radiography (PA-CR) techniques. Materials (patients) and methods: We obtained DES (D1-D4) images from 96 patients using DES and a high-resolution dynamic flat-panel detector in combination. We compared the DES images of these patients with their PA-CR images. The maximum time interval between performing DES and PA-CR was nine weeks. Two radiologists evaluated abnormal findings on DES and PA-CR images using a three-point scale, and reporting confidence was scored using a four-point scale. The intra- and interobserver agreement values of the scores were analyzed. Further, the radiation exposure doses during PA-CR and DES acquisitions were calculated. Results: The intra- and interobserver agreement values of PA-CR and DES images were good. The reporting confidence scores for DES were generally higher than those for PA-CR. Between bone-subtracted (D3) and soft-tissue-subtracted (D4) images, the former was more successful and useful in the evaluation of bone structures, whereas the latter was better in the evaluation of consolidation and/or solitary nodules. Conclusions: DES has the potential to improve the accuracy, reproducibility, and reporting confidence of thoracic radiography. It also has the potential to provide a better diagnosis of chest pathologies using relatively low dose radiation.

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INTRODUCTION: This experimental study compares the appropriateness of direct digital radiography (DDR) and ultrasonography at detecting soft-tissue wooden foreign bodies (FBs) in extremities. METHODS: Varying wooden FB splinters (2 mm, 5 mm and 10 mm) were inserted into eight porcine feet to simulate a patient presenting with a soft-tissue FB injury. Each of the FBs was placed in muscle distant, behind and near bone in the porcine feet. Control groups were used to check for false-positive diagnoses and, based on the presence of FBs; images were given a score depending on the level of visibility by the researcher. RESULTS: A higher detection rate was achieved for all FBs in muscle distant from bone using ultrasound. All of the 2 mm and 5 mm wooden FBs were not detected using DDR. The sensitivity in detecting the FBs was 5.8% and 30% in DDR and ultrasound respectively. CONCLUSION: Poor sensitivities and specificities were identified in this study. However, this study shows that ultrasound remains superior to DDR at identifying small foreign body objects. This study demonstrates that ultrasound can be a clinically effective tool for detecting suspected wooden FBs >5 mm in the foot and thus should be considered as the primary imaging modality of choice for referring clinicians.

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BACKGROUND: Periodontitis is an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms, resulting in destruction of the periodontal ligament and alveolar bone. Progressive loss of alveolar bone is the salient feature of periodontal disease. Accurate detection of periodontal disease with the use of radiographs helps in diagnosis, treatment and prognosis. AIMS: The present study aims to compare the efficacy of conventional intraoral periapical (IOPA) and direct digital radiographs (RVG) in detecting interdental alveolar bone loss using intrasurgical (IS) measurements as the gold standard. MATERIALS AND METHODS: Thirty patients elected to undergo periodontal flap surgery with periodontitis computing to 60 interdental alveolar defects on mandibular first molars were considered. IOPA and RVG were captured using standardized techniques. Bone loss measurements in IOPA and RVG were compared to the IS measurements. STATISTICAL ANALYSIS: Statistical analysis was carried out using student t test and ANOVA with the help of SPSS software and p-value <0.05 was considered as significant. RESULTS: Both IOPA and RVG underestimated the bone loss measurements when compared to IS measurements which was statistically significant (p<0.0001). Bone loss measurements in RVG were closer to IS measurements than IOPA. CONCLUSION: Both the radiographic techniques IOPA and RVG underestimated bone loss by 1.5-2.5 mm. RVG was superior to IOPA for the detection of interdental bone loss due to reduced time and radiation exposure to obtain the same diagnostic information.

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This study investigated the usefulness of the dose optimization strategy of increased tube voltage (kVp) and decreased tube current-exposure time product (mAs) (or high kVp-low mAs) by examining practitioners' assessments of perceived aesthetic and diagnostic quality of direct digital radiographs acquired using this strategy. Ninety-one practitioners (radiologists, radiology residents, radiographers, and radiography students) from eight clinical sites in Ontario examined three types of radiographs ("standard" image, +20 kVp image, and +30 kVp image) for anthropomorphic pelvis, chest, skull, and hand phantoms and rated (on a five-point scale) each image in regard to its perceived aesthetic quality, perceived diagnostic quality, and visualization of anatomic structures. Our primary findings are that for the pelvis, skull, and hand-although not the chest-images acquired using standard technical factors were rated significantly higher in diagnostic and aesthetic quality than those acquired using the high kVp-low mAs strategy. Despite this, both standard and dose-optimized images of the pelvis, skull, and hand were rated to be of acceptable diagnostic quality for clinical use. In conclusion, for the pelvis, skull, and hand, an increase of 20 kVp was an effective strategy to reduce dose while still acquiring images of diagnostic quality.

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OBJECTIVES: Digital radiography has become an integral part of dentistry. Digital radiography does not require film or dark rooms, reduces X-ray doses, and instantly generates images. The aim of our study was to compare the subjective image quality of two digital dental radiographic systems with conventional dental film. MATERIALS & METHODS: A direct digital (DD) 'Digital' system by Sirona, a semi-direct (SD) digital system by Vista-scan, and Kodak 'E' speed dental X-ray films were selected for the study. Endodontically-treated extracted teeth (n = 25) were used in the study. Details of enamel, dentin, dentino-enamel junction, root canal filling (gutta percha), and simulated apical pathology were investigated with the three radiographic systems. The data were subjected to statistical analyzes to reveal differences in subjective image quality. RESULTS: Conventional dental X-ray film was superior to the digital systems. For digital systems, DD imaging was superior to SD imaging. CONCLUSION: Conventional film yielded superior image quality that was statistically significant in almost all aspects of comparison. Conventional film was followed in image quality by DD, and SD provided the lowest quality images. Conventional film is still considered the gold standard to diagnose diseases affecting the jawbone. RECOMMENDATIONS: Improved software and hardware for digital imaging systems are now available and these improvements may now yield images that are comparable in quality to conventional film. However, we recommend that studies still use more observers and other statistical methods to produce ideal results.

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Cone beam computed tomography (CBCT) is an indispensable diagnostic imaging tool for dento-alveolar examination. CBCT scanning has become a valuable imaging modality in the field of Periodontology for the detection of very small osseous defects. A patient reported to the department of Periodontology with a complaint of loose teeth. Clinical and direct digital radiographic (DDR) examination revealed advanced periodontal destruction, but failed to diagnose the morphology of generalized osseous defects, around all the surfaces of each tooth. CBCT images were obtained for detailed examination of each and every osseous defect around all the teeth. Patient was then diagnosed with generalized aggressive periodontitis. Flap surgery was performed in order to eliminate the periodontal pockets, exposing and degranulating the osseous defects. Actual measurements of surgically exposed osseous defects were compared with that seen in CBCT images and found to be exactly identical. CBCT has proved to be as accurate in measuring osseous defects as direct measurements with a periodontal probe. Buccal and lingual periodontal defects that could not be diagnosed by conventional radiography can be identified with CBCT.

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AIM AND OBJECTIVE: To compare conventional and direct digital radiography (DDR) in working length measurement of the root canal and to assess the significance of the different enhancement modes provided by the software to visualize the file length. MATERIALS AND METHODS: Access cavities were prepared in 30 extracted maxillary central incisors. Size 15 k-file was introduced into the canal till it was flush with the apical foramen. The working length was calculated as 0.5 mm less than the vernier caliper measured length of each file. The files were then sealed with resin at their respective lengths. Intraoral periapical radiographs and direct digital radiographs were taken. Vernier caliper was used to measure the file length in the periapical radiographs, and standard, positive conversion, and colorize modes were used with the CDR system. A multiple regression analysis was conducted to give an accurate analysis between the actual file length and the different groups. RESULTS: There was no statistical significance between the different groups tested. The multiple regression analysis test showed that the positive and colorize modes more accurately corresponded to the actual file length. CONCLUSION: Both conventional radiography and DDR can be reliably used for working length determination. The positive and colorize modes enhancement features of DDR greatly improve the visual perception, leading to more accurate measurements.

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AIM: The purpose of this study was to investigate change of working length in curved molar root canals after preparation with Profile, ProTaper and K3 Rotary Nickel-Titanium (Ni-Ti) instruments. MATERIALS AND METHODS: One hundred and eighty maxillary and mandibular molars were divided into group I having root curvature angle <300 and group II having root curvature angle >300 comprising 90 teeth in each group based on Schneider's method. Group II and I were further divided into sub group A, B and C having 30 teeth each based on type of instrument used. Profiles, ProTaper and K3 Rotary Ni-Ti files were used to prepare mesial and buccal roots of molars. Radiography platform was made to allow technique for constant object to film distance and object to sensor distance. Conventional access opening was prepared in each tooth. Preoperative and postoperative working length was measured to an accuracy of 0.1 of mm on Dexis 3.0 direct digital radiograph's onscreen measurement device. RESULTS: Mean loss of working length varied from 0.28 to 0.92 mm. Highest working length loss was seen in ProTaper followed by K3 files and Profiles, which is statistically significant.

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Objective To compare the efficiency of computed radiography energy subtraction (ES-CR) with direct digital radiography (DR) in detecting the pulmonary soft-tissue signals.Methods The adult chest phantom including TRG was imaged by ES-CR and DR separately and was estimated by 6 radiologists with 5-value-differentiation method. ROC was used to analyze the performance of two systems. Images of DR and ES-CR of 28 patients with small lung cancer were diagnosed by 3 radiologists. Results The area under the ROC curves was 0. 727 in ES-CR and 0.827 in DR (Z= 2.96,P ＜ 0. 05). 28 small lung cancer patients were significantly different between two systems (x2 = 5.14,P ＜0. 05). Conclusions The true positive proportion of DR might be higher than that of ES-CR. ES-CR is inferior to DR in detecting pulmonary soft-tissue signals.

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Objective To explore the improvement effect of SLOT Scan technology (narrow seam exposure capture technology) and the radiography techniques on the quality of the scoliosis X-ray films in teenagers. Methods The Sonialvision Satire Ⅱ equipment of Shimadzu corporation and SLOT Scan were applied to take the radiography for 60 patients taller than 1.50 metres. All the data were collected through a continual exposure, and the images were sewn up through a seamless connec-tion software. Results Cervical, thoracic, and lumbar and sacral segments could clearly present at the same time on one X-ray film by seamless splicing, and the quality of one time radiograph was as good as one film. Conclusion As a new radiology technique, SLOT Scan can wipe off splitting arti-fact effectively and make the whole spine seamless present on one X-ray film. It helps the spinal sur-geons to observe, calculate and measure accurately. It is useful to choose the operation mode and judge the curative effect.

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Objective To explore the exposure condition of DDR, screen -film radiography and the radiation dose to patients, and evaluate value of the DDR system. Methods Five thousand images of DDR and screen-film radiography were selected and then analyzed by three junior radiologists and two senior radiologists. Results 1.The quality of the images was classified into grades A ,B ,C: grade A in 92.8 % , grade B in 7.2 % , grade C in 0% ,waste in 0 % for DDR group and grade A in 40.8% , grade B in 41.7 %,grade C in 15.5 % ,waste in 2% for screen-film radiography group. 2. The required voltage of DDR system raises 3-24kV than screen-film radiography and radiation exposure was increased about 25 % . Conclusions The imaging quality of DDR was obviously higher than the screen -film radiography, but the disadvantage of DDR system was the higher exposure condition required, which increase X-ray radiation dose for patients.

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Objective To summaize the experience of application of direct digital radiography and electrohydraulic shockwave lithotripsy in treatment of residual bile duct stones.Methods A retrospective analysis of clinical records of 60 patients with residual bile duct stones treated in our hospital from 2003 to 2006 was made.Results In 59(95.9%) of 60 cases the stones were removed completely,including successful removal in one time of application of this method in 57 Patients(95.0 %),and 2 applications in 2 Patients ﹙3.3 %).One case with bile duct stone complicated with dile duct cancer was unsuccessful.The biggest stone was 3.5 cm?2.5 cm?2.0 cm.No serious complications occurred and changed to operation.The 59 cases were followed up for 6 mo to l yr,and all had a successful outcome.Conclusions The method of combination of direct digital radiography and electrohydraulic shockwave lithotripsy in treatment of postoperative residual bile duct stones after operation can facilitate removal of residual bile duct stones.The procedure is a safe way of treating residual stones.

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Objective To investigate the advantages of DR images produced by tissue equalization(TE)technique in chest digital radiography(DR) compared with standard technique.Methods 100 images collected from DR chest images taken in our hospital in May,2003 were processed by TE technique and compare with standard DR images.Results The details in different thickness area of body could be revealed clearly in the same image produced by TE technique,while the display parameters should be adjusted repeatedly to reveal the details in standard chest digital radiography.Conclusion The visualization of image details can be obviously improved by using the TE technique and other details are not lossed.

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Objective To discuss the application value of the mobile DR in large-scale physical examination. Methods Compared each 500 chest images that collected for the physical examination by the mobile DR, direct digital radiography(DR), then did another comparison about each 300 chest images of mobile DR and phnendoskiascope, recorded them by no displayed, displayed and limpid-displayed. Results The resolution of images collected by the mobile DR was comparative with the ones collected by direct digital radiography, better than phnendoskiascope in showing details. Conclusion The mobile DR images have a good resolution ratio as DR images have, meanwhile, this machine is easy to be taken and removed Examination while DR could not, and therefore the machine can do large-scale physical whatever inside or outside.

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Objective To investigate multifunctional direct digital radiography system (DDR) in clinical practice, in order to improve the applied value of it.Methods EPEX DDR was performed in 1000 cases,these images were analysedby 3 senior radiologists and tried to find the best method of usually positions. Results The quality of DDR was assessed as grade A in73.00%, grade B in 22.70%, grade C in 4.30%, and no waste film.Conclusion DDR is easy to operate, fast in capturing image and can provide post-processing techniques, which will facilitate the accurate diagnosis of radiography.