The image quality of digital luminescent radiography (DLR) is sufficient for routine biplane chest radiography and for follow-up studies of heart size, pulmonary congestion, coin lesions, infiltrations, atelectasis, pleural effusions, and mediastinal and hilar lymph node enlargement. Chest radiography in the intensive care unit may in most cases be performed using the DLR technique. There is no need for repeat shots because of incorrect exposure, and the position of catheters, tubes, pacemakers, drains and artificial heart valves, the mediastinum, and the retrocardiac areas of the left lung are more confidently assessed on the edge-enhanced DLR films than on conventional films. Nevertheless, DLR is somewhat inferior to conventional film-screen radiography of the chest as it can demonstrate or rule out subtle pulmonary interstitial disease less confidently. There is no reduction of radiation exposure of the chest in DLR compared with modern film-screen systems. As a consequence, DLR is presently not in a position to replace traditional film-screen radiography of the chest completely.
In 350 patients with 870 pathologic findings comparative blind analysis of conventional chest films and biplane 100 mm photofluorographic images taken with the large-field image intensifier revealed high accuracy in the evaluation of coin lesions, hilar and pleural pathology, pulmonary vasculature and the right paratracheal stripe. Moderate central interstitial edema, more subtle interstitial changes particularly in the lung periphery including Kerley's B-lines, and calcifications in the hilum or the aortic arch are not visible in all cases for the evaluation of lesions of the ribs special films continue to be mandatory. Lateral views are of good quality. The spatial resolution of the large-field image intensifier was measured to be 4.5-5.2 LP/mm at the output phosphor, the spatial resolution of the 100 mm intensified images ranges from 2.6-3.8 LP/mm in the center. Mean skin dose was found to be 6.3 mrd in the p.a. projection which is less than 5% of the values registered in non-intensified photofluorography and even by factor 5 lower than in conventional chest x-ray using rare earth screens.
Using optimal equipment and an adequate examination technique, renal venous DSA for renal artery stenosis is today a diagnostic procedure in 98% of cases. Its sensitivity equals 85%, its specificity reaches 95%. Comparing accuracies and positive predictive values, renal venous DSA is superior to radionuclide studies. Pre-selection of patients with captopril as a pharmacologic test is expected to increase the predictive values of renal venous DSA and to confirm the hemodynamic significance of an angiographically detected renal artery stenosis.
Image quality and diagnostic significance of intravenous and intraarterial DSA following renal transplantation were assessed in 40 angiographic studies. In 27 of 40 DSA (67.5%) there were pathologic findings such as a renal artery stenosis, aneurysms or rejection within this selected group of patients. There were significant differences in image quality between intravenous and intraarterial DSA. The value of intravenous DSA is limited, particularly in patients with complex anastomosis, implanted polar arteries and kinking stenosis.
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