Radiation Protection Guidance for Diagnostic X Rays
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2. Screening Techniques
2. SCREENING TECHNIQUES 2.1 X-ray techniques the contrast and the spatial resolution are poor, making detection of small lesions difficult. The The original technique for mammography mammogram in Fig. 2.1b, from the same era, is of was introduced by Salomon in Germany in 1913, much higher quality and illustrates a cancer seen 18 years after the discovery of X-rays by Roentgen on the basis of an irregularly shaped mass (black (Salomon, 1913). A mammogram is formed by arrow). Fig. 2.1c shows a digital mammogram, recording the two-dimensional (2D) pattern of illustrating the enormous improvement that X-rays transmitted through the volume of the has occurred in both technology and technique. breast onto an image receptor. Breast cancer is Breast positioning, penetration of the tissue, and detected radiographically on the basis of four contrast are excellent, allowing visualization of major signs: a mass density with specific shape a small area of ductal carcinoma in situ (DCIS) and border characteristics, microcalcifications, seen on the basis of microcalcifications, and, architectural distortions, and asymmetries more importantly, providing the opportunity to between the radiological appearance of the left detect an immediately adjacent high-grade inva- and right breast (Kopans, 2006). These signs sive cancer 1.7 mm in diameter. are often very subtle, and in order for them to Excellent image quality is an essential compo- be detected accurately and when the cancer is at nent but not, on its own, a sufficient component the smallest detectable size, the technical image to ensure a high level of accuracy in cancer detec- quality of the mammograms must be excellent tion. -
Neurological Critical Care: the Evolution of Cerebrovascular Critical Care Cherylee W
50TH ANNIVERSARY ARTICLE Neurological Critical Care: The Evolution of Cerebrovascular Critical Care Cherylee W. J. Chang, MD, FCCM, KEY WORDS: acute ischemic stroke; cerebrovascular disease; critical FACP, FNCS1 care medicine; history; intracerebral hemorrhage; neurocritical care; Jose Javier Provencio, MD, FCCM, subarachnoid hemorrhage FNCS2 Shreyansh Shah, MD1 n 1970, when 29 physicians first met in Los Angeles, California, to found the Society of Critical Care Medicine (SCCM), there was little to offer for the acute management of a patient suffering from an acute cerebrovascular Icondition except supportive care. Stroke patients were not often found in the ICU. Poliomyelitis, and its associated neuromuscular respiratory failure, cre- ated a natural intersection of neurology with critical care; such was not the case for stroke patients. Early textbooks describe that the primary decision in the emergency department was to ascertain whether a patient could swallow. If so, the patient was discharged with the advice that nothing could be done for the stroke. If unable to swallow, a nasogastric tube was inserted and then the patient was discharged with the same advice. In the 50 intervening years, many advances in stroke care have been made. Now, acute cerebrovascular patients are not infrequent admissions to an ICU for neurologic monitoring, observa- tion, and aggressive therapy (Fig. 1). HISTORY Over 50 years ago, stroke, previously called “apoplexy” which means “struck down with violence” or “to strike suddenly,” was a clinical diagnosis that was confirmed by autopsy as a disease of the CNS of vascular origin (1). In the 1960s, approximately 25% of stroke patients died within 24 hours and nearly half died within 2 to 3 weeks. -
Cone Beam Computed Tomography (CBCT) Page 1 of 13
Cone Beam Computed Tomography (CBCT) Page 1 of 13 Dental Policy An Independent licensee of the Blue Cross Blue Shield Association Title: Cone Beam Computed Tomography (CBCT) Professional Institutional Original Effective Date: January 1, 2007 Original Effective Date: January 1, 2007 Revision Date(s): May 14, 2013; Revision Date(s): May 14, 2013; December 31, 2013; May 13, 2015; December 31, 2013; May 13, 2015; April 27, 2016; January 18, 2017; April 27, 2016; January 18, 2017; February 15, 2018; July 3, 2019; February 15, 2018; July 3, 2019, October 1, 2020; May 21, 2021 October 1, 2020; May 21, 2021 Current Effective Date: May 21, 2021 Current Effective Date: May 21, 2021 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care. Treating health care providers are independent contractors and are neither employees nor agents of Blue Cross and Blue Shield of Kansas and are solely responsible for diagnosis, treatment and medical advice. If your patient is covered under a different Blue Cross and Blue Shield plan, please refer to the Medical Policies of that plan. -
Radiation Safety in Dental Radiography
Dental Radiography Series Radiation Safety in dental radiography. The goal of dental radiography is to obtain diagnostic information while keeping the exposure to the patient and dental staff at minimum levels. While some exposure to radiation is acceptable in medical practice, it should be understood that levels of radiation exposure to patients, dental staff, and other nearby occupants should be kept to As Low As Reasonably Achievable (ALARA) to reduce health risks from ionizing radiation. Any methods that can reduce patient and area radiation exposures without major difficulty, great expense or inconvenience, should be practiced. Practitioners must always consider the risk of patient exposure with the benefit of diagnosis. Radiograph Guidelines 4 Radiation safety considerations 4 Exposure 5 Patient selection 5 Film 6 Rectangular Collimation 7 Image Density 7 Film Cassettes 7 Minimal Exposure 8 Exposure Protection Basic principals of radiation safety Additional radiation safety controls commonly utilized for dental facilities Engineering controls 9 Summary 9 References Radiograph Guidelines One way to do this is with the use of radiographic patient All x-ray equipment, regardless of date of manufacture, is selection criteria. subject to state and federal x-ray equipment regulations. Guidelines for the prescription of dental radiographs have Although proper filtration is not usually a problem with been developed by an expert panel of dentists sponsored modern equipment, older x-ray machines should be tested by the public health service. by a radiation physicist or qualified technician to verify the presence of the correct amount of filtration. A free brochure is available from Carestream Dental (see last page for ordering information) publication The kilovoltage or kVp setting is one of the most 8616 “Guidelines for prescribing dental radiographs.” important factors that determines the image contrast, The guidelines are voluntary and are intended only as a as well as dosage to the patient. -
Amorphous Lead Oxide (A-Pbo): Suppression of Signal Lag Via Engineering of the Layer Structure Received: 12 June 2017 O
www.nature.com/scientificreports OPEN Amorphous lead oxide (a-PbO): suppression of signal lag via engineering of the layer structure Received: 12 June 2017 O. Semeniuk1,2, O. Grynko1,2, G. Juska3 & A. Reznik2,4 Accepted: 25 September 2017 Presence of a signal lag is a bottle neck of performance for many non-crystalline materials, considered Published: xx xx xxxx for dynamic radiation sensing. Due to inadequate lag-related temporal performance, polycrystalline layers of CdZnTe, PbI2, HgI2 and PbO are not practically utilized, despite their superior X-ray sensitivity and low production cost (even for large area detectors). In the current manuscript, we show that a technological step to replace nonhomogeneous disorder in polycrystalline PbO with homogeneous amorphous PbO structure suppresses signal lag and improves time response to X-ray irradiation. In addition, the newly developed amorphous lead oxide (a-PbO) possesses superior X-ray sensitivity in terms of electron-hole pair creation energy W± in comparison with amorphous selenium – currently the only photoconductor used as an X-ray-to-charge transducer in the state-of-the-art direct conversion X-ray medical imaging systems. The proposed advances of the deposition process are low cost, easy to implement and with certain customization might potentially be applied to other materials, thus paving the way to their wide-range commercial use. Amorphous and polycrystalline modifcations of wide band gap semiconductors are of paramount importance in modern electronics, since they allow large device area production at low cost. However, the transition from crystalline to non-crystalline materials is technologically challenging since structural disorder may lead to degra- dation of the material performance. -
Pneumoencephalographic Planimetry in Neurological Diseaset
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.32.3.241 on 1 June 1969. Downloaded from J. Nearol. Neurosurg. Psychiat., 1969, 32, 241-248 Pneumoencephalographic planimetry in neurological diseaset H. E. BOOKER, C. G. MATTHEWS, AND W. R. WHITEHURST2 From the Epilepsy Center and Department of Neurology, University of Wisconsin, Madison, Wisconsin, U.S.A. The outline of the ventricular system on the In the present investigation planographic rather pneumoencephalogram (PEG) can be easily than linear measures of ventricular size were used. measured and lends itself to quantification. Several The subjects were not selected on the basis of a methods have been developed which utilize linear particular aetiology nor on the basis of presence or measures of the ventricles, or ratios of ventricle to absence of asymmetry of the lateral ventricles. skull size. Planographic measurements of the area of Detailed clinical and electroencephalographic data the ventricles have been employed in a few studies, were available on all subjects for purposes of but have generally been dismissed as too cumber- diagnostic classification, and, in addition, a stan- some for use (Bruijn, 1959). dardized battery of neuropsychological tests pro- While a number of previous investigators have viding quantitative measurement of intellectual and Protected by copyright. related quantitative PEG findings to clinical motor-sensory status was administered to the neurological and psychometric data, most studies majority of the subjects. PEG data on a group of have suffered from one or more limitations. Studies subjects without clinical, neurological, or electro- reporting measurements on a large number of PEGs encephalographic evidence of neurological disease have usually been limited in amount and specificity were also included for comparison purposes. -
Emission Tuned-Aperture Computed Tomography: a Novel Approach to Scintimammography
Emission Tuned-Aperture Computed Tomography: A Novel Approach to Scintimammography Frederic H. Fahey, Kerry L. Grow, Richard L. Webber, Beth A. Harkness, Ersin Bayram, and Paul F. Hemler Division of Radiologic Sciences, Wake Forest University School of Medicine, and Department of Physics, Wake Forest University, Winston-Salem, North Carolina 1 or more distant sites (3). Early detection, therefore, plays Emission tuned-aperture computed tomography (ETACT) is a an essential role in the fight against breast cancer. Although new approach to acquiring and processing scintimammography mammography is currently the best imaging approach for data. A gamma camera with a pinhole collimator is used to breast cancer screening, several factors may limit its accu- acquire projections of the radionuclide distribution within the racy. Dense breasts, breast implants, or scars may either breast. Fiducial markers are used to reconstruct these projec- tions into tomographic slices. Simulation and phantom experi- resemble a tumor or hide true small tumors on the mam- ments were performed to evaluate the potential of the ETACT mogram. As a result, false-positive as well as false-negative method. Methods: In the simulation study, a hemispheric object incidents are increased. Mammography has a relatively high of 15 cm in diameter was constructed to model a breast. A sensitivity (88%), although dense or large breasts may re- ray-tracing technique was used to generate ideal projections. duce this. However, it has a low specificity (67%) (4). These were blurred and noise was added to create images that Scintimammography using 99mTc-labeled sestamibi has resemble scintigraphic images. Tumor size, pinhole size, and target-to-nontarget radioactivity ratios (TNTs) were varied. -
Essential Tips for Dental Radiographers
Essential Tips for Dental Radiographers The Academy of Dental Learning and OSHA Training, LLC, designates this activity for 2 continuing education credits (2 CEs). Martin S. Spiller, DMD Health Science Editor: Megan Wright, RDH, MS Publication Date: May 2010 Updated Date: December 2019 Expiration Date: December 2021 The Academy of Dental Learning and OSHA Training, LLC is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at ADA.org/CERP. Conflict of Interest Disclosure: ADL does not accept promotional or commercial funding in association with its courses. In order to promote quality and scientific integrity, ADL's evidence- based course content is developed independent of commercial interests. Refund Policy: If you are dissatisfied with the course for any reason, prior to taking the test and receiving your certificate, return the printed materials within 15 days of purchase and we will refund your full tuition. Shipping charges are nonrefundable. California Registered Provider Number: RP5631 Answer Sheet: Essential Tips for Dental Radiographers 1. _______ 3. _______ 5. _______ 7. _______ 9. _______ 2. _______ 4. _______ 6. _______ 8. _______ 10. _______ Name: ________________________________________ Profession: _________________________ License State: ____________ License Number: ________________ Expiration Date Address City: ____________________________________ State: __________ Zip Code: Telephone:________________________________ Fax: ____________________________________ E-mail: If you have downloaded the course and printed the answer sheet from the Internet please enter payment information below. -
Radiographic Diagnostic Aids: a Review © 2019 IJADS Received: 01-02-2019 Dr
International Journal of Applied Dental Sciences 2019; 5(2): 271-276 ISSN Print: 2394-7489 ISSN Online: 2394-7497 IJADS 2019; 5(2): 271-276 Radiographic diagnostic Aids: A review © 2019 IJADS www.oraljournal.com Received: 01-02-2019 Dr. Panna Mangat, Dr. Anil K Tomer, Dr. Afnan Ajaz Raina, Dr. Faizan Accepted: 03-03-2019 Bin Ayub, Dr. Akankshita Behera, Dr. Nitish Mittal, Dr. Megna Bhatt Dr. Panna Mangat Professor, Department of Conservative and Dr. Ayush Tyagi Dentistry & Endodontics D.J. College of Dental Sciences and Research, Modinagar, Ghaziabad, Uttar Pradesh, Abstract India Presently diagnosis has shown a major growth in the field of Endodontics. Newer technologies have evolved in a way that human elements are being enriched in a much better way to ensure proper and Dr. Anil K Tomer Professor and Head, Department of correct diagnosis. Therefore, for a successful diagnostician, a necessity arises to keep abreast of all the Conservative Dentistry & Endodontics new methods for correct diagnosis and treatment. The aim of this review therefore is to assess the D.J. College of Dental Sciences and usefulness of some radiographic diagnostic aids and techniques used in endodontic therapy to make the Research, Modinagar, Ghaziabad, Uttar correct pulpal diagnosis. Pradesh, India Dr. Afnan Ajaz Raina Keywords: Radiographic diagnostic, aids, endodontics Post Graduate Student, Department of Conservative Dentistry & Endodontics D.J. College of Dental Sciences and Introduction Research, Modinagar, Ghaziabad, Uttar Pradesh, India Diagnosis is arguably the most critical component of all dental treatment, and Endodontics is no exception. Stedman’s Medical Dictionary describes clinical diagnosis as ‘‘the Dr. -
Dental Radiography
Dental Radiology Made Easy - Tips and Tricks for Great Rads! Mary L. Berg, BS, LATG, RVT, VTS(Dentistry) Beyond the Crown Veterinary Education Lawrence, KS [email protected] Here are some quick tips for great x-rays every time: 1. You need a diagnostic x-ray – not a perfect x-ray. A diagnostic x-ray allows for the visualization of 2-3 mm of bone around the apex of the root and the level of the alveolar bone. The crown does not need to be on the x-ray. 2. The entire tooth does not need to be on one view. If both roots are visible but on two separate x-rays, it’s okay! 3. Get all the teeth in as few views as possible. This saves time and gives a quick survey of the oral cavity. If more detail is needed, additional view should be obtained. 4. Every patient, every time! Not only will this help you become faster at taking x-rays, but it is also better medicine. Remember the patients can’t tell us where it hurts. 5. Proper positioning of the animal is key! Place the animal (both dog and cat) in sternal recumbency for the maxillary views and dorsal recumbency for the mandibular. Ensure that the dental arcade is parallel to the table, and the mouth is straight, not tilted in either direction. 6. The sensor (film) should always be placed with the teeth on the very edge of the sensor with the remainder of the sensor inside the mouth, and the sensor should be flat or parallel to the table for maxillary views. -
Maxillofacial Imaging
3 ▼ MAXILLOFACIAL IMAGING SHARON L. BROOKS, DDS, MS ▼ SELECTION CRITERIA The role of imaging in oral medicine varies greatly with the ▼ IMAGING MODALITIES AVAILABLE IN DENTAL type of problem being evaluated. Certain problems, such as OFFICES AND CLINICS pain in the orofacial region, frequently require imaging to Intraoral and Panoramic Radiography determine the origin of the pain. For other conditions, how- Digital Imaging ever, such as soft-tissue lesions of the oral mucosa, imaging Conventional Tomography offers no new diagnostic information. ▼ IMAGING MODALITIES AVAILABLE IN HOSPITALS The variety of imaging techniques available to the clinician AND RADIOLOGY CLINICS has grown in number and in degree of sophistication over the Computed Tomography years. While this means that there is an imaging procedure Magnetic Resonance Imaging that will provide the information desired by the clinician, it Ultrasonography Nuclear Medicine also means that choosing the best technique is not necessarily Contrast-Enhanced Radiography an easy process. This chapter first explores the underlying principles the ▼ IMAGING PROTOCOLS Orofacial Pain clinician should consider when deciding whether imaging is Disease Entities Affecting Salivary Glands appropriate for the case in question and then discusses the Jaw Lesions imaging techniques that are available in dental offices and in ▼ BENEFITS AND RISKS referral imaging centers. Examples of specific imaging proto- cols are then described, followed by a discussion of risk-ben- efit analysis of imaging in oral medicine. ▼SELECTION CRITERIA The decision to order diagnostic imaging as part of the evalu- ation of an orofacial complaint should be based on the prin- ciple of selection criteria. Selection criteria are those histori- cal and/or clinical findings that suggest a need for imaging to provide additional information so that a correct diagnosis and an appropriate management plan can be determined. -
Confidential: for Review Only
BMJ Confidential: For Review Only Temporal trends in the use of tests in UK primary care: a retrospective analysis of 250 million tests, 2000 – 2015. Journal: BMJ Manuscript ID BMJ.2018.044789 Article Type: Research BMJ Journal: BMJ Date Submitted by the Author: 26-Apr-2018 Complete List of Authors: O'Sullivan, Jack; University of Oxford, Centre for Evidence-based medicine, Nuffield Department of Primary Care Health Sciences Stevens, Sarah; University of Oxford, Primary Care Health Sciences Hobbs, FD Richard; University of Oxford, Nuffield Department of Primary Care Health Science Salisbury, Chris; University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine Little, Paul; University of Southampton, Medical School, Goldacre, Ben; University of Oxford, Primary Care Health Sciences Bankhead, Clare; University of Oxford, Nuffield Department of Primary Care Health Sciences Aronson, Jeffrey; University of Oxford, Primary Health Care Perera, Rafael; University of Oxford, Primary Health Care Heneghan, Carl; Oxford University, Primary Health Care Too much medicine, Primary Care, Imaging, Laboratory tests, Radiology, Keywords: Workload https://mc.manuscriptcentral.com/bmj Page 1 of 100 BMJ 1 2 3 Temporal trends in the use of tests in UK primary care: a retrospective analysis of 250 million 4 tests, 2000 – 2015. 5 Jack W. O’Sullivan,1,2 Sarah Stevens,2 FD Richard Hobbs,2 Chris Salisbury,3 Paul Little,4 Ben 6 1,2 1,2 1,2 1,2 1,2 7 Goldacre, Clare Bankhead, Jeffrey K. Aronson, Rafael Perera, and Carl Heneghan . 8 9 10 1CentreConfidential: for Evidence-Based Medicine, Nuffield For Department Review of Primary Care HealthOnly Sciences, 11 University of Oxford, OX2 6GG, UK 12 2 13 Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK 14 3Centre for Academic Primary Care, School of Social and Community Medicine, University of 15 16 Bristol, BS8 2PS, UK 17 4Primary Care and Population Sciences, University of Southampton, Southampton, SO17 1BJ, UK 18 19 20 21 Jack W.