Zero-added-dose gastrointestinal film studies

A technique is described to produce diagnostic quality 70 mm x 60 mm films of upper GI fluoroscopic examinations by photography of the video-displayed image on a "slave" monitor, obtained at a dose of 0.01 milligray (1 millirad) for a 20 cm water equivalent phantom. Because the photograph is the same image already being observed, the films require no added dose over that needed for an adequate fluoroscopic examination. Diagnostic films can be made from the replay of a videocassette recorder. With exposure times of 1/30th of a second, movement blur is easily prevented.

The clinical application of forearm and hand blood flow measurements using a gamma camera

A new method of measuring blood flow to forearms and hands during reactive hyperemia is described. Subjects are positioned with forearms and hands over a gamma camera, and the circulation below the elbows is isolated for 4 minutes with pneumatic cuffs. The remaining blood pool is labeled with technetium-99m-labeled human serum albumin given via a vein in the dorsum of the foot. The rate of rise of activity in the arms after cuff release is measured from the gradient of time activity curves, and these are calibrated for flow by counting a sample of venous blood. Blood flow per unit volume is obtained from measurements of the limb volume, done by water displacement. Results for eight normal control subjects showed a mean flow per unit volume to forearm plus hand of 32.9 +/- 6.4 ml/100 ml/min and to hand alone 36.5 +/- 6.9 ml/100 ml/min. Case studies of patients with a variety of large- and small-vessel diseases are presented, illustrating the use of the technique to aid diagnosis and measure response to treatment.

Photographic method for Brückner and Hirschberg testing

An apparatus for strabismus detection was designed to allow photographing fundus and corneal reflexes for Brückner and Hirschberg testing, respectively. Photographs of adult subjects with simulated strabismic deviations were viewed by two groups of observers, optometry students and optometry faculty. In general there was no significant difference in testing results between the two groups. Subject error produced unreliable Brückner results. However, Hirschberg testing was effective approximately 80% of the time in detecting a deviating eye in strabismus of magnitudes of about 5 delta. Anisometropia in Brückner testing was also investigated. Magnitudes of 2.00 D or greater significantly affected results. Clinical application of the photographic Hirschberg test may have potential value as a screening method. The photographic Brückner test is not recommended for adults; its reliability in children requires investigation.

Producing still images in arthroscopy

Videotape recordings of arthroscopic examinations and procedures provide excellent real-time records, but cannot take the place of still images for teaching, referrals, patient education, and publishing. New uses of still images may also emerge as techniques for obtaining them become more convenient and reliable. Current methods for obtaining still images include direct arthroscopic photography, video-screen photography, thermal video printers, and photographic video printers. Although direct arthroscopic photography provides the highest quality images, photographic video printers designed for arthroscopic use appear to provide the best balance of image quality, convenience, and versatility.

Improved resolution of specular micrographs

The purpose of specular photomicrography of the corneal endothelium is to depict fine cellular morphology and to determine total cell density. The use of silver-based photographic films to record the cells and generate enlarged paper prints yields the highest resolution currently possible. Previously, the quality of these prints was diminished when the highly resolved cell image was combined with the standardized grid used for quantification, since the sub-optimal quality of the grid's plastic substrate caused optical aberrations. We present a prototype device and a modified technique that enables the full resolution of the microscope to be represented on photographic prints and allows highly detailed views of the endothelial mosaic to be depicted with or without the standardized grid.

[Cervicography--a useful method for the early detection of changes in the uterine cervix]

Cervicographic findings were analysed in 156 patients of whom 71 had previously been found to have cervical changes (group I) and 85 were regularly examined within the periodic systematic examination programme (group II). In group I there were 15.5% negative cervicographic findings, 80.3% suspect, and 4.2% technically inadequate. Out of suspect findings, carcinoma in situ or invasive carcinoma were detected in 54.4%, of which 9.7% were cytologically false negative. In group II, in 69.4% of cases, some colposcopic changes (non-malignant) were observed, while in 3 out of 26 colposcopically normal findings, there were some changes in the cervicogram.

Corneal topography: a new photokeratoscope

The assessment of the topography of the cornea is an important modality in the management of surgical procedures complicated by astigmatism. Additionally, the outcome of corneal refractive surgery is often best illustrated by photokeratoscopy. Currently available photokeratoscopes suffer from a number of deficiencies that include (i) the lack of topographic detail from the central cornea, (ii) the difficulty in transporting these units, (iii) the cost of such units. A photokeratoscope which addresses these shortcomings is described.

Melanoma-pigmented lesion center

Early diagnosis of cutaneous malignant melanoma is of critical importance as thin lesions equate with increased survival. Detection has been made easier by the development of a computer-programmed, high-resolution camera capable of detecting changes in surface area as well as low-level color changes, which are associated with radial (noninvasive) growth.

Visual assessment of facial elastosis using photographs as a measure of cumulative ultraviolet exposure

Because solar ultraviolet (UV) exposure is ubiquitous, it is difficult to quantify in human populations. We developed a method to index cumulative UV damage, based upon visual manifestations of facial actinic elastosis. Four photographic slides were taken of each subject's facial skin. These slides were projected on a screen and graded by consensus of 2 raters using a 5-point relative severity scale. Rating disagreements were resolved by a skilled dermatologist who acted as adjudicator. High photographic quality was maintained by standardization of camera settings, lighting, and photographic techniques. Inter- and intrarater variability in grading was minimized by training using standard slides and by practice. This index has been tested in 2 large epidemiologic studies. The method proved highly reliable and, within categories of age and tanning ability, a valid measure of cumulative UV exposure. In addition, this method appeared superior to others in speed, ease of use and cost.

Evaluation of a non-mydriatic camera in Indian and European diabetic patients

The value of the Canon CR3-45NM non-mydriatic fundus camera in screening for diabetic retinopathy has been assessed in two ethnic groups, namely, 45 Indian and 40 European diabetic patients. There was 72% agreement between ophthalmoscopy by an ophthalmologist and the photographic assessment, and 100% agreement on clinically important lesions requiring treatment. However, peripheral retinal lesions, seen on ophthalmoscopy but lying outside the photographic field, occurred in 4% of eyes. 6% of photographs were totally unassessable and an additional 12% were only partially assessable. The prevalence and severity of retinopathy was similar in Indian and European patients. The advantages and disadvantages of the non-mydriatic camera in screening for diabetic retinopathy are discussed.

[Analysis of gait using motography in healthy children and patients with neurologic disorders. II: Quantitative analysis]

Light pattern recording of movements by Motografie results in data representing changes in space and time; single pictures of these curves can be analysed in detail. The method was used for gait analysis in two healthy children, in a boy with minimal cerebral dysfunction and hyperactivity, and in two patients with spastic diplegia. From describing all phases of gait cycles different variables were chosen to assess movement patterns quantitatively; thus, curves could be described by various parameters. Differences were seen between normal, mildly impaired and severely handicapped children. Results obtained are in good agreement with a qualitative analysis of pictures and with data from the literature using different methods.

[Analysis of gait using motography in healthy children and patients with neurologic disorders. I: Qualitative analysis]

Light pattern recording of movements is applicable to assess changes in space and time as well by using single photographic pictures. The method called Motografie has the advantage to work with a special light source; therefore, it is useful in clinical practice and research. Data can be analysed by describing pictures (qualitative analysis) as well as by quantitative measurements from the light pattern curves. By using Motografie gait pictures were studied in two healthy children, in a boy with minimal cerebral dysfunction and hyperactivity, and in two patients suffering from spastic diplegia. Movement curves from different parts of the body (shoulders, hands, hips, knees, feet) could be described in regard to their pattern and quality. In comparing healthy, mildly impaired and severely handicapped children specific features were noted to characterize different gait patterns. This is useful in clinical diagnosis and practicable to assess developmental changes as well as results of therapeutic measures in movement disorders.