Search

Comparison of puncture deviation and puncture duration between computed tomography (CT)- and C-arm CT (CACT)-guided puncture performed by residents in training (RiT).In a cohort of 25 RiTs enrolled in a research training program either CT- or CACT-guided puncture was performed on a phantom. Prior to the experiments, the RiT's level of training, experience playing a musical instrument, video games, and ball sports, and self-assessed manual skills and spatial skills were recorded. Each RiT performed two punctures. The first puncture was performed with a transaxial or single angulated needle path and the second with a single or double angulated needle path. Puncture deviation and puncture duration were compared between the procedures and were correlated with the self-assessments.RiTs in both the CT guidance and CACT guidance groups did not differ with respect to radiologic experience (p = 1), angiographic experience (p = 0.415), and number of ultrasound-guided puncture procedures (p = 0.483), CT-guided puncture procedures (p = 0.934), and CACT-guided puncture procedures (p = 0.466). The puncture duration was significantly longer with CT guidance (without navigation tool) than with CACT guidance with navigation software (p 0.001). There was no significant difference in the puncture duration between the first and second puncture using CT guidance (p = 0.719). However, in the case of CACT, the second puncture was significantly faster (p = 0.006). Puncture deviations were not different between CT-guided and CACT-guided puncture (p = 0.337) and between the first and second puncture of CT-guided and CACT-guided puncture (CT: p = 0.130; CACT: p = 0.391). The self-assessment of manual skills did not correlate with puncture deviation (p = 0.059) and puncture duration (p = 0.158). The self-assessed spatial skills correlated positively with puncture deviation (p = 0.011) but not with puncture duration (p = 0.541).The RiTs achieved a puncture deviation that was clinically adequate with respect to their level of training and did not differ between CT-guided and CACT-guided puncture. The puncture duration was shorter when using CACT. CACT guidance with navigation software support has a potentially steeper learning curve. Spatial skills might accelerate the learning of image-guided puncture.· The CT-guided and CACT-guided puncture experience of the RiTs selected as part of the program "Researchers for the Future" of the German Roentgen Society was adequate with respect to the level of training.. · Despite the lower collective experience of the RiTs with CACT-guided puncture with navigation software assistance, the learning curve regarding CACT-guided puncture may be faster compared to the CT-guided puncture technique.. · If the needle path is complex, CACT guidance with navigation software assistance might have an advantage over CT guidance..· Meine TC, Hinrichs JB, Werncke T et al. Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology. Fortschr Röntgenstr 2022; 194: 272 - 280.ZIEL: Vergleich der Punktionsabweichung und -dauer zwischen Computertomografie (CT) – und C-Arm-CT (CACT) -gesteuertem Punktionsverfahren bei Anwendung durch Assistenzärzte in Weiterbildung (AiW).In einer Kohorte von 25 AiW, die Teil einer wissenschaftlichen Förderung waren, wurden entweder CT- oder CACT-gesteuerte Punktionen an einem Phantom durchgeführt. Vor Beginn wurden der Weiterbildungsstand, die Erfahrung mit Spielen eines Musikinstruments, mit Videospielen und mit Ballsportarten und die Selbsteinschätzung von manueller Geschicklichkeit und räumlichem Denkvermögen abgefragt. Jede/r AiW führte 2 Punktionen durch, wobei die 1. Punktion mit einem transaxialen bzw. einfach angulierten Nadelpfad und die 2. Punktion mit einem einfach bzw. doppelt angulierten Nadelpfad erfolgte. Punktionsabweichung und -dauer wurden zwischen den Verfahren verglichen und mit den Selbsteinschätzungen korreliert.Die beiden Gruppen der AiW zeigten keine Unterschiede in der Erfahrung in der Radiologie (p = 1), in der Angiografie (p = 0.415) und in der Anzahl bereits durchgeführter Punktionen gesteuert durch Ultraschall (p = 0,483), CT (p = 0,934) und CACT (p = 0,466). In der CT (ohne Navigationssoftware) war die Punktionsdauer signifikant länger als mit der CACT-Bildsteuerung mit Navigationssoftware (p 0,001). Bei der Punktionsdauer zeigten sich keine signifikanten Unterschiede zwischen der 1. und 2. Punktion im CT (p = 0,719), während die 2. Punktion mit CACT schneller durchgeführt werden konnte (p = 0,006). Die Punktionsabweichung war weder signifikant zwischen CT- und CACT-Bildsteuerung (p = 0,337), noch zwischen der 1. und 2. Punktion der jeweiligen Verfahren (CT: p = 0,130; CACT: p = 0,391). Die Selbsteinschätzung der manuellen Geschicklichkeit korrelierte nicht mit der Punktionsabweichung (p = 0,059) und -dauer (p = 0,158). Das subjektive räumliche Denkvermögen zeigte eine moderate positive Korrelation zur Punktionsabweichung (p = 0,011), aber nicht zur -dauer (p = 0,541).Die AiW erreichten eine dem Ausbildungsstand entsprechende, klinisch adäquate Punktionsabweichung unter CT- und CACT-Bildsteuerung. Die CACT-gesteuerten Punktionen mit Unterstützung durch Navigationssoftware wurden schneller durchgeführt, und auch die Lernkurve war mit CACT-Bildsteuerung steiler. Räumliches Denkvermögen kann möglicherweise das Erlernen bildgesteuerter Punktionen beschleunigen.· Die Erfahrung mit Punktionen war in einer Gruppe von AiW, die im Rahmen des Programms der Deutschen Röntgengesellschaft e. V. „Forscher-für-die-Zukunft“ ausgesucht wurden, dem Weiterbildungsstand entsprechend.. · Trotz kollektiv geringerer Erfahrung der radiologischen AiW mit der CACT-gesteuerten Punktion mit Navigationssoftwareunterstützung ist die Lernkurve gegenüber der einfachen CT-Punktion möglicherweise steiler.. · Bei schwierigen Punktionswegen könnte die CACT-Bildsteuerung mit Softwareunterstützung einen Vorteil in der Durchführung gegenüber der konventionellen CT-Bildsteuerung haben..· Meine TC, Hinrichs JB, Werncke T et al. Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology. Fortschr Röntgenstr 2022; 194: 272 – 280.

An evaluation of cancer risk based on organ-absorbed dose is underway for the Japanese Epidemiological Study on Low-Dose Radiation Effects (J-EPISODE), which has analyzed health effects in association with radiation exposure evaluated with the personal dose equivalent Hp(10). Although the concept of effective dose and its operational definition of Hp(10) are widely used for radiological protection purposes, effective dose is not recommended for epidemiological evaluation. Organ-absorbed dose was instead adopted for the IARC 15-Country Collaborative study (15-Country study), the International Nuclear Workers Study (INWORKS), the Mayak worker study, and the Life Span Study (LSS) of atomic bomb survivors. The reconstruction method in J-EPISODE followed in principle the approach adopted in the 15-Country Study. As part of the approach of J-EPISODE, a conversion factor from photon dosimeter reading to air kerma was developed using dosimeter response data, which were measured by the experiment using an anthropomorphic phantom, and it was confirmed that the 15-Country study’s assumption of photon energy and geometry distribution in a work environment applied to Japanese nuclear workers. This article focuses on a method for reconstructing the conversion factor from photon dosimeter reading to organ-absorbed photon dose for a Japanese nuclear worker cohort. The model for estimating the conversion factor was defined under the assumption of a lognormal distribution from three concerned bias factors: (1) a dosimeter reading per air kerma, i.e., dosimeter response; (2) an organ-absorbed dose per air kerma; and (3) a factor relating to the differences in dose concepts and calibration practices between the roentgen dosimeter era and the present. Dosimeter response data were cited from the companion paper. Data on organ-absorbed photon dose per air kerma were estimated using a voxel phantom with the average Japanese adult male height and weight. The bias factor for the recorded dose in the roentgen era was defined, considering the backscatter radiation from the human body. The estimated values of organ-absorbed photon dose per air kerma were almost the same as those in ICRP Publication 116, revealing that the effect of differences in body size was almost negligible. The conversion factors from dosimeter reading to organ-absorbed dose were estimated by period (the roentgen era or from then), nuclear facility type (nuclear power plant or other), dosimeter type, and tissue or organ. The estimated conversion factors ranged from 0.7 to 0.9 (Gy Sv−1). The estimated cumulative organ-absorbed photon dose for the participants of J-EPISODE demonstrated that organ-absorbed dose values were approximately 0.8 times the recorded doses if neglecting dose-unit differences. J-EPISODE reconstructed an organ-absorbed dose conversion factor and will evaluate the risk of cancer mortality and morbidity using the organ-absorbed dose in the future.

Roentgen's photographs with the "new kind of rays" triggered a worldwide storm of enthusiasm in all social circles. It was a stroke of luck that the photographic dry plates available to him were also sensitive to invisible X-rays. The discovery, research and utilization of X-rays are based on methods for making them visible, from fluorescent screens to photographic plates and digital X-ray detectors. From this point of view, this paper aims to outline the 125-year success story of X-ray imaging from its discovery to the recent development of photon-counting detectors. The scientific-historical view during the transition from the 19Röntgens Fotografien mit der „neuen Art von Strahlen“ lösten einen weltweiten Begeisterungssturm in allen gesellschaftlichen Kreisen aus. Dabei war es ein Glücksfall, dass die ihm zu Verfügung stehenden fotografischen Trockenplatten auch für die unsichtbaren X-Strahlen empfindlich waren. Entdeckung, Erforschung und Nutzbarmachung von Röntgenstrahlen beruhen auf Methoden zur deren Sichtbarmachung, vom Fluoreszenzschirm über die Fotoplatte bis hin zum digitalen Röntgendetektor. Aus diesem Blickwinkel heraus möchte diese Arbeit die 125-jährige Erfolgsgeschichte der Röntgenbildgebung von der Entdeckung bis zur jüngsten Entwicklung photonenzählender Detektoren skizzieren. Die wissenschaftshistorische Betrachtung am Übergang des 19. zum 20. Jahrhundert offenbart eine eindrucksvolle Zeit tiefgreifender wissenschaftlicher und gesellschaftlicher Umbrüche, in der revolutionäre Entdeckungen und technologische Entwicklungen zu gewaltigen Fortschritten der Medizin führten. Die gegenseitige Befruchtung von Physik und Medizin und deren Verquickung mit Erfindergeist, Ingenieurskunst und unternehmerischem Geschick schufen die eindrucksvollen Möglichkeiten der bildgebenden Diagnostik von heute. Diese Arbeit begleitet die Röntgenvorlesung, die der Autor am 13. November 2020 im Röntgen-Geburtshaus im Rahmen von dessen Eröffnung sowie des feierlichen Abschlusses des 101. Deutschen Röntgenkongresses in Remscheid-Lennep gehalten hat. KERNAUSSAGEN:: · Die Entwicklung der Computertomografie markiert einen Meilenstein der methodischen Weiterentwicklung der Bildgebung mit Röntgenstrahlen.. · Im Detektorpixel werden die unseren Sinnen unzugänglichen Röntgenstrahlen in digitale elektrische Impulse umgewandelt, aus denen der Computer die Bilder errechnet.. · Photonenzählende Röntgendetektoren lassen deutliche diagnostische Vorteile für klinische Anwendungen erwarten.. ZITIERWEISE: · Schlemmer H, The Eye of the CT Scanner: The story of learning to see the invisible or from the fluorescent screen to the photon-counting detector. Fortschr Röntgenstr 2021; 193: 1034 – 1049.

The history of X-ray crystallography and X-ray diffraction, and their important contributions to science as a whole, is profound. From the first images of Wilhelm Roentgen and Madame Curie taking a...

BACKGROUND CONTEXT Intraoperative three-dimensional (3D) computed tomography (CT) imaging has become increasingly popular in spine surgery. Previous spine surgeon radiation exposure research has focused largely on procedures using fluoroscopy, however, few studies have been performed on the subject since the introduction of the 3D imaging systems. As a result, concerns have re-emerged over surgeon radiation exposure and the effectiveness of operating room (OR) protocols for decreasing workplace radiation. Current radiation safety guidelines require surgeons wear full body protective lead while any type of radiation is being administered during surgery. As a result, local institutions do not allow for the use of free-standing lead shields for sole radiation protection in the operating room. However, there is no data available to demonstrate whether the additional personal lead is required, or if in fact the lead shield alone is sufficient. PURPOSE This study investigated the effectiveness of a free-standing lead shield in reducing spine surgeon radiation exposure in the operating room during intraoperative imaging. STUDY DESIGN/SETTING A prospective clinical research study at a large, tertiary care center. PATIENT SAMPLE Twenty-seven patients undergoing instrumented spinal procedures between June and August 2019. OUTCOME MEASURES Fluoroscopy time, total fluoroscopy dose delivered, 3D dose delivered, total 3D spins, number of HD spins, number of standard spins, number of fluoroscopic images, number of spine levels operated on, patient size setting, shield distance from patient, radiation dose in front of shield, radiation dose behind shield. METHODS Twenty-seven instrumented spinal procedures using the O-Arm Imaging System (Medtronic, Minneapolis, MN) were observed to determine radiation exposure to a spine surgeon standing behind a lead shield in the OR. Two thermoluminescent dosimeters were used to measure scatter radiation in front of and behind lead shields. Both fluoroscopy and intraoperative CT based radiation exposure was recorded. The dosimeter readings were compared to determine the degree of radiation attenuation by the lead shield. Regression analysis of the exposure values from behind the shield, shield distance from the patient, and radiation dose delivered by the imaging system was utilized to estimate the number of cases required to surpass annual exposure limits. Case numbers were calculated for the highest “worst case” and “average case” exposure values. The safe annual occupation exposure limit determined by the National Council on Radiation Protection is five roentgen equivalent man (rem) or 50,000 microsieverts (μSv). RESULTS Average surgeon radiation exposure per case was 0.694 μSv (SD: 0.501, Range: 0.105–2.167) behind the lead shield compared to 14.577 μSv (SD: 9.864, Range: 2.185–44.492) in front of the lead shield. The average radiation dose reduction by the lead shield was 13.962 μSv (SD: 9.49, Range: 2.08–42.72) per case, which is equivalent to an average of 95.65% (SD: 1.71) radiation attenuation by lead shielding. If surgeons stand behind lead shields in the OR, the annual number of 3D image-guided spinal procedures required to surpass exposure limits is 15,479 and 67,060 based on “worst case” and “average case” analyses, respectively. CONCLUSIONS Our study demonstrates standing behind intraoperative lead shields is very effective at decreasing radiation exposure to surgeons. Additionally, surgeon radiation doses behind lead shielding fall far below annual exposure limits. Surgeons should not need additional protective equipment when a lead shield is used.

Objective: to systematize the existing techniques of ultrasound-guided percutaneous radiofrequency ablation.Materials. The research subjects were 34 patients with focal liver malignancies who had undergone radiofrequency ablation at Gomel Regional Clinical Oncology Center from 2014 to 2019.Results. The data about the existing techniques of ultrasound-guided percutaneous radiofrequency ablation have been systematized. The possibilities to increase the ablation efficiency of the liver tumor foci have been determined. The main components of the treatment algorithm that allow to achieve the best ablation results have been identified.Conclusion. Strict adherence to the described techniques of radiofrequency ablation which takes into account tumor vascularisation makes it possible to achieve complete necrosis of the foci with no complications in 82.4 % of the patients, and minor complications that do not require therapy in 17.7 % of the patients [9].

Background Ninety years after the Dutch theoretical physicist H.A. Lorentz died, detailed investigation of his scientific heritage yielded the set of nine original prints of radiographs that W.C. Roentgen made during his experiments and had sent him, among half a dozen other scientists, on January 1st, 1896. Main text Through communications with different experts and literature research, the author describes these nine prints and how they relate to the first publication Roentgen wrote about his discovery of the X-rays. Conclusions The combination of Roentgen’s first publication on his X-ray discovery and the nine radiographs provides insight as to which aspects of the discovery were considered important by Roentgen and how he carried out the experiments to be able to describe these aspects.

When Roentgen discovered the X-rays 125 years ago, his finding was soon recognized as a breakthrough in research and awarded with the Nobel Prize. Today X-rays are widely used in natural and applied sciences and even art. In medicine, X-rays have made an impressive impact far beyond their original domain of diagnostic imaging. In cancer treatment, X-rays are indispensable for reaching the goal of uncomplicated and lasting tumor control. Using the possibilities of modern technology and the innovative mind of physicians and physicists, definitive cancer cure cannot only be achieved by combination of surgery and radiation, but also by radiotherapy alone. One prominent example is the application of single high radiation doses with optimal geometrical precision through image-guided stereotactic radiotherapy. The article aims to highlight past, current, and future sustainable developments in oncology in general, but in radiation oncology, especially. We discuss the very complex challenge of generating evidence by clinical research. In this context, the tumor registries play a very important role. The data of tumor registries and the results of clinical studies demonstrate the benefit for cancer patients who experienced individualized radiotherapy. For cancer cure, it is most important to treat in an early, localized stage of the disease.

X rays have been used for medical imaging since RONTGEN's fascinating discovery 125 years ago. The first radiographs of human hands were made public less than a month after his famous paper. The conventional X-ray sources integrated into the CT-machines of today’s hospitals still rely on the same physical principles. X-ray imaging has traditionally offered high spatial resolution and low contrast for soft tissues such as the brain. Magnetic resonance imaging is therefore the method of choice for brain imaging in a clinical setting, although for cellular resolution studies it suffers from limited spatial resolution. The gold standard in post mortem brain imaging is histology, which involves fixation, embedding, physical sectioning, staining, and optical microscopy. Currently, section thickness limits isotropic voxel sizes to 20 μm. Advanced X-ray sources including synchrotron radiation facilities offer complementary modalities such as phase-contrast imaging and spatially resolved small-angle X-ray scattering. We showed that X-ray phase contrast of the human cerebellum with micrometer resolution yields complementary three-dimensional images to magnetic resonance microscopy with even better contrast and spatial resolution. Grating interferometry enabled us to visualize individual Purkinje cells in the nonstained cerebellum. Taking advantage of well-established paraffin embedding, Purkinje cells were visualized within the human cerebellum even with conventional instrumentation. Hard X-ray nano-holotomography allowed for label-free, three-dimensional neuroimaging beyond the optical limit with a spatial resolution below 100 nm. Spatially resolved smallangle X-ray scattering permitted the localization of periodic nanostructures such as myelin sheaths on square-inch brain slices and included the orientational information on the axons. These developments have contributed to the establishment of virtual histology and extended the conventional histology to the third dimension. Further advances are required to image the entire human brain with an isotropic micrometer resolution and to suitably handle the petabyte datasets.

Spectrum-Roentgen-Gamma is an international X-ray astrophysical space observatory, planned to be launched in 2019. The spacecraft will operate in the vicinity of the Lagrangian point L 2 of the Sun-Earth system. The nominal lifetime of the mission is 7 years, and it includes all-sky survey and pointed observations in the 0.1–15 keV band. The paper describes technical constraints of the mission, covering launch scenario, spacecraft structure and ground data relay network, and a design of suitable operational orbits. In addition, opportunities to achieve a suitable operational orbit are discussed, including a scenario with a lunar gravity assist and a transfer with an intermediate orbit.

Objectives To derive conversions of antiquated exposure data into modern equivalents and to apply these in the assessment of the skin dose of pelvic radiographs since 1896. Methods The literature 1896–2018 was searched for implicit and explicit dose information. The early implicit dose data contained now obsolete descriptions of radiation quality and quantity for long since disappeared X-ray systems of limited efficiency. Converting the old information into modern specifications was achieved using contemporary data and computer simulations. Final dose calculations were done with modern software. Explicit radiation doses of later date reported in old quantities and units were adapted according to current recommendations. Results For the period before 1927 conversion algorithms for spark gap data and penetrometer hardnesses to high voltage could be derived. Electrical and X-ray efficiencies of several old röntgen systems were determined. Together they allowed reconstruction of 53 doses. After 1927 doses were generally explicitly specified; 114 were retrieved. Although an enormous spread was observed, the average skin dose was reduced by a factor of about 400. Conclusions Antiquated exposure data were successfully used for dose reconstruction. Extreme dose variability was a constant. Efforts to cut down doses were effective as skin doses went down from sub-erythema values to about one milligray. Electronic supplementary material The online version of this article (10.1186/s13244-019-0710-1) contains supplementary material, which is available to authorized users.

Background Conventional radiography (CR) is the imaging method of choice in monitoring bone remodelling and other stability parameters after total hip arthroplasty (THA). Quantitative roentgen- or computed-tomography-based methods to determine bone density are prone to metal artifacts and often very costly, which is why they are not used as standard in a clinical setting. Since subjective assessment of bone remodelling in CR also has a certain susceptibility to errors, semi-quantitative methods have been developed to help approximate periprosthetic bone density development via CR to open up an additional tool for documentation of radiographic THA follow-up. Objective Proof-of-principle of a newly designed imaging-software-aided method to measure relative bone density around the femoral stem in a series of conventional radiographs following THA. Methods Eighty-six patients with hip modular tapered, fluted titanium stems were selected from the clinical database and series of baseline and postoperative follow-up radiographs were obtained after 24 and 48 weeks. Relative bone densities were measured per Gruen zones G1-7 with the use of an open-source image analysis package (ImageJ) by means of greyscale histograms. In addition, subjective evaluation of selected cases was performed by three independent, blinded orthopedic surgeons. Besides descriptive and nonparametric analyses, intra-class correlation (ICC) was performed and objective and subjective results were compared by linear regression analysis. Results Two individual cases are presented as a proof-of-principle. Increase or decrease of bone density could be measured correctly over time in each case. In a collective analysis there were no significant differences in mean relative bone densities between groups after 24 and 48 weeks, although a positive tendency was visible towards increased bone formation over time. Individual analyses by Gruen zones revealed that some zones, namely the proximal ones (e.g. G6), exhibit a broader scattering than others over time. This could be explained by the design of the evaluated tapered revision stem that achieves distal fixation and allows for proximal micromotion. Correlation analysis with subjective ratings (inter-rater reliability ICC = 0.71) showed a positive correlation with objective results, suggesting a feasibility of the method for clinical use. Conclusions In conclusion the presented method is an easy and accessible tool to quantify relative bone density changes during THA follow-up. It shows a positive correlation to established subjective assessment of bone remodelling and may therefore serve as a quantitative supplement in clinical documentation.

The Working Group Uroradiology and Urogenital Diagnosis of the German Roentgen Society (DRG) revised and updated the recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate in a consensus process and harmonized it with the managing board of German Roentgen Society and Professional Association of the German Radiologist (BDR e. V.). These detailed recommendation define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer and describe in detail the topic 1. anamnestic datas, 2. termination of examinations and preparation of examinations, 3. examination protocol and 4. MRI-(in-bore)-biopsy. KEY POINTS:: · The recommendations for preparation and scanning protocol of the multiparametric MRI of the Prostate were revised and updated in a consensus process and harmonized with the managing board of German Roentgen Society (DRG) and Professional Asssociation of the German Radiologist (BDR).. · Detailed recommendations are given for topic 1. anamnestic datas, 2. termination and preparation of examinations, 3. examination protocoll and 4. MRI-(in-bore)-biopsy.. · These recommendations define the referenced "validated quality standards" of the German S3-Guideline Prostate Cancer.. CITATION FORMAT: · Franiel T, Asbach P, Beyersdorff D et al. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Examination Protocol. Fortschr Röntgenstr 2021; 193: 763 - 776.Die AG Uroradiologie und Urogenitaldiagnostik der Deutschen Röntgengesellschaft hat die Empfehlungen zur Vorbereitung und Durchführung der multiparametrischen MRT der Prostata im Konsensusverfahren und in Abstimmung mit den Vorständen der Deutschen Röntgengesellschaft und des Berufsverbandes der Deutschen Radiologen überarbeitet und aktualisiert. Diese aktualisierten Empfehlungen definieren die in der deutschen S3-Leitlinie Prostatakarzinom referenzierten „geltenden Qualitätsstandards“ und gehen detailliert auf die Themen 1. Anamnestische Angaben, 2. Untersuchungsterminierung und -vorbereitung, 3. Untersuchungsprotokoll und 4. MRT- (in-bore) -Biopsie ein. KERNAUSSAGEN:: · Die Empfehlungen zur Vorbereitung und Durchführung der multiparametrischen MRT der Prostata wurden von der AG Uroradiologie und Urogenitaldiagnostik der Deutschen Röntgengesellschaft in Abstimmung mit den Vorständen der Deutschen Röntgengesellschaft und des Berufsverbandes der Deutschen Radiologen überarbeitet und aktualisiert.. · Es werden detailiert Empfehlungen zu 1. Anamnestische Angaben, 2. Untersuchungsterminierung und -vorbereitung, 3. Untersuchungsprotokoll und 4. MRT-(in-bore)-Biopsie gegeben.. · Diese Empfehlungen definieren die in der S3-Leitlinie Prostatakarzinom referenzierten „geltenden Qualitätsstandards“.. ZITIERWEISE: · Franiel T, Asbach P, Beyersdorff D et al. mpMRI of the Prostate (MR-Prostatography): Updated Recommendations of the DRG and BDR on Patient Preparation and Examination Protocol. Fortschr Röntgenstr 2021; 193: 763 – 777.

Magnetic Resonance Imaging (MRI) is a very innovative, but at the same time complex and technically demanding diagnostic method in radiology. It plays an increasing role in high-quality and efficient patient management. Quality assurance in MRI is of utmost importance to avoid patient risks due to errors before and during the examination and when reporting the results. Therefore, MRI requires higher physician qualification and expertise than any other diagnostic imaging technique in medicine. This holds true for indication, performance of the examination itself, and in particular for image evaluation and writing of the report. In Germany, the radiologist is the only specialist who is systematically educated in all aspects of MRI during medical specialty training and who must document a specified, high number of examinations during this training. However, also non-radiologist physicians are increasingly endeavoring to conduct and bill MRI examinations on their own. In this position statement, the following aspects of quality assurance for MRI examinations and billing by radiologists and non-radiologist physician specialists are examined scientifically: Requirements for specialist physician training, MRI risks and contraindications, radiation protection in the case of non-ionizing radiation, application of MR contrast agents, requirements regarding image quality, significance of image artifacts and incidental findings, image evaluation and reporting, interdisciplinary communication and multiple-eyes principle, and impact on healthcare system costs. The German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists are critical with regard to MRI performance by non-radiologists in the interest of quality standards, patient welfare, and healthcare payers. The 24-month additional qualification in MRI as defined by the physician specialization regulations (Weiterbildungsordnung) through the German state medical associations (Landesärztekammern) is the only competence-based and quality-assured training program for board-certified specialist physicians outside radiology. This has to be required as the minimum standard for performance and reporting of MRI exams. Exclusively unstructured MRI training outside the physician specialization regulations has to be strictly rejected for reasons of patient safety. The performance and reporting of MRI examinations must be reserved for adequately trained and continuously educated specialist physicians.· MR imaging plays an increasing role due to its high diagnostic value and serves as the reference standard in many indications.. · MRI is a complex technique that implies patient risks in case of inappropriare application or lack of expertise.. · In Germany, the radiologist is the only specialist physician that has been systematically trained in all aspects of MRI such as indication, performance, and reporting of examinations in specified, high numbers.. · The only competence-based and quality-assured MRI training program for specialist physicians outside radiology is the 24-month additional qualification as defined by the regulations through the German state medical associations.. · In view of quality-assurance and patient safety, a finalized training program following the physician specialization regulations has to be required for the performance and reporting of MRI examinations..· Hunold P, Bucher AM, Sandstede J et al. Statement of the German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists on Requirements for the Performance and Reporting of MR Imaging Examinations Outside of Radiology. Fortschr Röntgenstr 2021; 193: 1050 - 1060. Die Magnetresonanztomografie (MRT) ist ein sehr innovatives, aber zugleich komplexes und technisch aufwendiges Verfahren in der Radiologie. Ihr Stellenwert für hochqualitatives und effizientes Patientenmanagement nimmt stetig zu. Die Qualitätssicherung hat in der MRT eine besondere Bedeutung, da Fehler vor und während der Untersuchung oder bei der Befundung schnell zu einem Patientenrisiko führen können. Daher erfordert die MRT eine höhere ärztliche Qualifikation und Expertise als andere bildgebende Diagnoseverfahren. Dies bezieht sich auf die Indikationsstellung, die Durchführung und im Besonderen auf die Auswertung und Befunderstellung. Der Radiologe ist der einzige Facharzt, der schon in der Weiterbildung sämtliche Aspekte der MRT erlernen und in definierter, hoher Anzahl nachweisen muss. Aber auch nichtradiologische Fächer bemühen sich zunehmend, selbstständig MRT-Untersuchungen durchführen und v. a. abrechnen zu dürfen. In diesem Positionspapier werden auf wissenschaftlicher Basis die folgenden Aspekte zur Qualitätssicherung von MRT-Untersuchungen und Leistungserbringung durch Radiologen und nichtradiologische Fachärzte beleuchtet: Anforderungen an die ärztliche Weiterbildung, Risiken der MRT und Kontraindikationen, Strahlenschutz bei nichtionisierender Strahlung, Anwendung von MRT-Kontrastmitteln, Anforderungen an die Untersuchungsqualität, Bedeutung von Artefakten und Nebenbefunden, Befundung und Erstellung des Befundberichts, interdisziplinärer Austausch und Mehraugenprinzip sowie Auswirkungen auf die Kosten für das Gesundheitssystem. DRG, DGNR und GPR stehen der Durchführung von MRT-Untersuchungen durch Nichtradiologen im Interesse von Qualitätsstandards, Patientenwohl und Kostenträgern kritisch gegenüber. Die Weiterbildungsordnungen der Landesärztekammern bieten mit der 24-monatigen „Zusatz-Weiterbildung Magnetresonanztomographie“ die einzige kompetenzbasierte und qualitätsgesicherte Weiterbildungsmöglichkeit für Fachärzte außerhalb des Faches der Radiologie. Diese muss als Mindeststandard für die Durchführung und Befunderstellung von MRT-Untersuchungen gefordert werden. Der alleinige Nachweis von Fortbildungen in der MRT ist – ohne entsprechende Weiterbildung – aus Gründen der Patientensicherheit abzulehnen. Durchführung und Befunderstellung von MRT-Untersuchungen müssen adäquat weitergebildeten und kontinuierlich fortgebildeten Fachärztinnen und Fachärzten vorbehalten bleiben. · Die MRT hat als Diagnoseverfahren aufgrund ihrer Aussagekraft einen stetig wachsenden Stellenwert und gilt bei vielen Indikationen als der Referenzstandard.. · Die Methode MRT ist in vielerlei Hinsicht komplex und birgt bei unsachgemäßer Anwendung und fehlender Expertise Gefahren für Patienten.. · Nur in der Weiterbildung zum Facharzt für Radiologie werden sämtliche Aspekte der MRT hinsichtlich Indikationsstellung, Durchführung und Befunderstellung systematisch erlernt und in definierter und hoher Anzahl nachgewiesen.. · Die einzige kompetenzbasierte und qualitätsgesicherte Weiterbildungsmöglichkeit für nichtradiologische Fachärzte ist die 24-monatige „Zusatz-Weiterbildung Magnetresonanztomographie“ nach den Weiterbildungsordnungen der Landesärztekammern.. · Im Interesse der Qualitätssicherung und Patientensicherheit muss für die Durchführung und Befunderstellung von MRT-Untersuchungen eine abgeschlossene Weiterbildung nach Weiterbildungsordnung gefordert werden..· Hunold P, Bucher AM, Sandstede J et al. Statement of the German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists on Requirements for the Performance and Reporting of MR Imaging Examinations Outside of Radiology. Fortschr Röntgenstr 2021; 193: 1050 – 1061.

Radiation dosimetry is based on exposure defined as C/kg (Roentgen). The energy transferred by photons to a medium is called KERMA, and the subsequent absorption of energy in a medium is quantified as dose, measured in Gray. Due to the different effects of radiation in different tissues as well as the need for radiation safety and protection standards, dose is further described in Sieverts for equivalent radiation dose and effective radiation dose. Radiation measurements are performed by various types of detectors.

Roentgen discovered X-rays in 1895 (Henderson in Art J 47:323–340, 1988). In 1896, it was used in medical imaging, taking X-ray pictures of women’s fingers. Subsequently, the researchers established a projection imaging model based on the particle nature of the X-ray light source. At present, this technology has become a necessary means for clinical medical diagnosis, industrial flaw detection, and quality inspection (Ducros et al. in Med Phys 44:e174–e187, 2017). To obtain a clear image of the structure of light-element objects, X-ray phase-contrast imaging has been developed.

Treatment of cancer requires multidisciplinary team approach. Radiotherapy (RT) is an integral part of the comprehensive cancer care and is required in around 60–70% patients diagnosed with cancer at some point of the time in the course of disease. Sir Wilhelm Conrad Roentgen discovered X-rays in 1895 and since then it is being therapeutically used to treat cancer. This chapter aims to give insight in basic principles of Radiation Oncology for the surgeons.

The discovery of X-rays by Wilhelm Conrad Rontgen on November 8, 1895 is without doubt one of the most important discoveries in medicine. Examination procedures based on the use of these X-rays, such as conventional X-ray, fluoroscopy, or computed tomography, now form an integral part of the diagnostic basis of almost all diseases. Through interventional, X-ray-based procedures, radiology today is also an integral part not only of diagnostics but also of therapy. X-ray technology is subject to continuous change through scientific and technical innovation. In the 125 years since the discovery of X-rays by Wilhelm Conrad Rontgen, it has been possible to develop new X-ray-based examination procedures and to improve X-ray technology both, in terms of resolution and accuracy, all with a reduction in radiation exposure of patients. New developments such as automatic dose modulation and special reconstruction algorithms now make it possible to perform an examination with only a very low dose of radiation. Highly specialized software enables X-ray images to be viewed in different planes, reconstructions and multidimensional views, thus further increasing diagnostic accuracy. In the meantime, computer-based techniques are no longer only used for the preparation of X-ray examinations and image representation, but increasingly also for the evaluation of the X-ray images. In the future, it can be expected that radiologists will be supported in the evaluation of X-ray examinations by methods of artificial intelligence. These new computer-based evaluation methods will make it possible to extract additional information from X-ray images. The scientific activities of the radiologists organized in the German Radiological Society (Deutsche Rontgengesellschaft e. V.) are making significant contributions to this continuous innovation thus enabling the further development of the “shining” possibilities created by Wilhelm Conrad Rontgen. On this 175th birthday of Wilhelm Conrad Rontgen, however, it is also important to preserve the past. The Rontgen birth house in Remscheid-Lennep is the central example. Deutsche Rontgengesellschaft e. V. acquired the house in 2011: it reopened in 2020 in a renovated state to mark the 175th birthday of Wilhelm Conrad Rontgen. A combination of exhibition space and conference rooms will interactively communicate the “shining life” of Mr. Rontgen and create space for scientific exchange.

Since November 8, 1895, the German physicist W.C. Roentgen discovered X-rays and used them in the clinic, the diagnosis of bone and joint diseases has been greatly improved. Imaging examination of the hip joint plays an important role in the diagnosis and differential diagnosis of hip joint diseases. The most used Imaging studies of hip joint include X-ray, CT, and MRI.

Background The purpose of this prospective matched paired study is to compare the in vivo migration patterns using Ein Bild Roentgen Analyze femoral component of shortened vs standard-length stems cemented line-to-line in primary total hip arthroplasty (THA) at 2-year follow-up. Methods We prospectively included the first 50 consecutive primary cemented THAs in 50 patients using a 12% shortened stem (AmisK group) of which design was derived from the original Charnley-Kerboull (CK) femoral components. These 50 patients were matched paired to 50 patients from a historical series of patients who underwent primary THAs using standard-length CK stems (CK group) with available long-term results, including Ein Bild Roentgen Analyze femoral component data at 2-year follow-up. Results Body mass index was significantly higher (P = .007) in the AmisK vs the CK group. At the 2-year follow-up, the mean subsidence was 0.65 mm (0-1.40) in the AmisK group vs 0.68 mm (0.07-1.43) in the CK group (P = .73). When using a 1.5-mm threshold, none of the stems in either group was considered to have subsided. Femoral cortical thickening in zones 3 and 5 occurred in 6 of the 50 hips (12%) in the AmisK group vs 20 (40%) of the 50 hips in the CK group (P = .003). Conclusion Our study showed that a shortened highly polished double-tapered stem cemented line-to-line provided similar results including minimal subsidence as its standard-length counterpart, with significantly less distal femoral cortical thickening. However, longer term survival analysis still needs to be determined.

Why took it nearly four decades, from the first evidence of artificial creation of bremsstrahlung, noted indirectly in literature in 1857 by Julius Pluecker, Professor of mathematics and physics in Bonn, Germany, to Professor Conrad Wilhelm Roentgen's breaking discovery and announcement of X-rays in 1895? Following introductory remarks on the difficulties adjusting the parameters required to generate X-rays and the way medical X-rays occupied clinical routine after Roentgen's revolutionary discovery, and answering the question at the beginning, this paper will discuss in depth the paths taken for improvement up to the present, and some of the culs-de-sac.

Every organism is known to have different structural and biological system, specifically in human immunity. If the immune system weakens, the body is susceptible to disease especially pneumonia disease. Pneumonia disease is caused by the bacterium Streptococcus pneumonia, and according to the World Health Organization (WHO), it is identified as the leading cause of death in children worldwide, which is about 16%, for those under the age of 5. Meanwhile, someone who is predicted to have pneumonia by a doctor is recommended for an X-ray. Convolutional neural networks (CNNs) is an accurate method to help the doctor's predicted correctly. CNNs is divided into two important parts, feature extraction layer (convolutional layer and pooling layer) and fully connected layer. CNNs method is commonly used for image data classification. Therefore, CNNs is suitable to classify pneumonia based on lung X-ray in order to obtain accurate prediction results. And then, the results can be seen based on the graph of the accuracy value and the loss value. When CNNs method applied on the dataset, an accuracy rate of 97% was obtained. Based on accuracy rate, it shows that CNNs can be applied to image data (especially lung X-ray) for classification of pneumonia disease.

Introduction Demographic change and demand for high quality of life lead to increasing implantation numbers. Aim of this study was to compare the Plasmafit® cup to Allofit® and Plasmacup®. Methods The study included 174 patients who had received 33 Plasmacup®, 68 Allofit® and 73 Plasmafit® cup implants. These were reviewed postoperatively, after 6 months control and after 12 months. Results No significant progressive migration could be discovered in any of the cup systems. At each follow-up the cups showed nearly constant values. Conclusions All examined acetabular cups showed excellent migration behavior within the first 12 postoperative months.

Discovery of X-rays by W.K. Roentgen on November 8, 1895, and the possibility of using them for imaging of the human body was a real revolution in medicine at that time...

Purpose This work presents a kinematic evaluation of a cruciate retaining highly congruent mobile bearing total knee arthroplasty design using dynamic Roentgen sterephotogrammetric analysis. The aim was to understand the effect of this implant design on the kinematics of prosthetic knees during dynamic activities. Methods A cohort of 15 patients was evaluated at nine month follow-up after surgery. The mean age was 74.8 (range 66–85) years. The kinematics was evaluated using the Grood and Suntay decomposition and the Low-Point (LP) methods. Results ?tlsb=-0.15pt?>From sitting to standing up position, the femoral component internally rotated (from − 11.3 ± 0.2° to − 7.0 ± 0.2°). Varus–valgus rotations were very close to 0° during the whole motor task. LP of medial condyle moved from an anterior position of 12.0 ± 0.2 mm to a posterior position of − 12.4 ± 0.2 mm; LP of the lateral condyle moved from an anterior position of 8.1 ± 0.2 mm to a posterior position of − 12.4 ± 0.2 mm, showing a bi-condylar rollback where both condyles moved parallel backward. Moreover, the femoral component showed anterior translation with respect to the tibia from 80° to 20° (from − 4.9 ± 0.2 mm to 3.3 ± 0.2 mm), then a posterior translation from 20° to full extension was identified (from 3.3 ± 0.2 mm to 0.5 ± 0.2 mm). Conclusions Paradoxical anterior femoral translation and absence of medial-pivoting motion were recorded, highlighting the role of the symmetric deep dishes insert as main driver of the kinematic of this TKA design.

Introduction Assessing left atrial (LA) size is an integral part of the cardiac evaluation in dogs. Left atrial size is routinely evaluated by thoracic radiographs or echocardiography. Objectives The objectives of the study were to assess agreement of subjective radiographic left atrial enlargement (LAE) between readers, to compare subjective radiographic LAE with echocardiography, and to assess the accuracy and reliability of commonly used Roentgen signs for LAE. Animals One hundred one dogs with thoracic radiographs and echocardiography performed on the same day at a veterinary teaching hospital were retrospectively reviewed. Methods Thoracic radiographs were reviewed by two cardiologists, two radiologists, and two small animal rotating interns. Radiographs were evaluated for the subjective presence and severity of LAE and for seven Roentgen signs. Echocardiographic LA size was evaluated objectively by the left atrial-to-aortic root ratio and LA volume indexed to body weight. Interreader agreement of radiographic LAE evaluation and agreement between radiographic LAE assessment and echocardiographic LAE were assessed by linearly weighted kappa and intraclass correlation coefficient. Results Interreader agreement for the presence and degree of radiographic LAE ranged from moderate to substantial. The agreement between subjective radiographic LAE and echocardiographic LAE was moderate. Single Roentgen signs had poor to fair correlation with echocardiographic LAE. Conclusions The present study found that interreader agreement for radiographic classification of LAE was substantial among specialists and moderate for all readers. Subjective, global assessment of radiographic LAE is better than using any single Roentgen sign.