870

Technical
:

..

.-

#{149}
#{149} . -

.;

:-#{149}

Digital
Diana

Radiography:

L. Novak1

and Barry

Uses

and Limitations

into print about

the method,

we have noted

a number

of contributions
to the literature claiming experience
with,
what at first glance would seem to be, applications
of our
technique,
generally under the rubric, Digital Radiography
[i]. A careful
review
of the literature
has resulted
in the
somewhat
surprising
discovery
that virtually all the authors
claiming expertise in Digital Radiography
are in fact reporting

about some type of computerized

system that has nothing to
do with Digital Radiography
as we know it. Their use of the
term Digital Radiography
in this context is obviously in error.
As inventors of the true Digital Radiography,
we feel compeHeci #{231}
describe, for once and for all, the only tried and true
method of Digital Radiography.

Materials

and

is quite simple. The digit, after calibration,

parallel to the dimension
read from the digit, the

August 21 , 1988; accepted after revision July 29, 1988. RevIsions

in question

is placed on the radiograph

3). The distance is then
90#{176}
(dse
or counterContinued application of the
given radiograph culminates
ratios, areas, and volumes

(Fig.

digit reoriented

clockwise),

and the process is repeated.

method
as frequently as needed for a
utilization. From the linear measurements,
can be calculated by conventional
formulas.
There have been attempts to use radiographs

of digits in similar

applications,
with daims
that this could be done quite handily. However, difficulties
in viewing through the combined
density of two
radiographs
make this approach impractical.

Calibration

Technique

In any system

of measurement,
precise calibration
of the device
is crucial. We use a calibration device
obtained
Unified Technical
Standards of Washington, DC (NUTS of Washington)
[2]. The digit in question is placed in
close proximity to the calibration device, and points of reference are
noted (Fig. 4). In the perfect digit, the length between
the tip of the
digit and the first knuckle (1 knuckle unit or KU) will be 1 in. (2.54321
cm). Assuming no anomalies, each finger will have 3 KUs so that 3
KU
1 finger knuckle unit or 1 FKU. Once having calibrated
a digit,
the calibration
remains
constant,
assuming
no growth
spurts or
sudden onset of acromegaly. If the calibrated length is not an easily
remembered
unit, such as 1 in., the appropriate conversion factor
can be tattooed on the digit for ready reference.
against

known
standards
from the National

BenefIts

Methods

Use of Digital Radiography

requires two elements:
(1) a digit (Fig.
1) and (2) a radiograph (Fig. 2). In practice, application of the method

Received

of the Method

F. Bates

As radiology, and indeed all of medicine, strives for more

precise quantification
of pathology,
physicians must ensure
they are precisely and consistently
recording significant items
of measure for any pathologic processes that they encounter.
Or, at least that seems like a good idea to us.
To satisfy our compelling urge for quantitative radiographic
description,
we have been using for some time a technique
of digitally determined measurements
(DDM) or, when applied
to radiology, Digital Radiography.
We have found this to be
a handy,
accurate,
convenient,
and very cost-effective
method.
While innate levels of modesty have prevented our
rushing

Note

The

In Operations
first

elimination

received August

benefit

from the use of our digital

ofrulers(savefor

calibration

items).

system

is the

As radiologists

30, September 7, 16, 28, October 9 and 21 , final revision November

4, 1988.

This work was supported In part by our own funds. In fact, It was supported entirely by our own funds. There Isnt a funding agency anywhere
us a penny for this work, and dont think we didnt tryl So much for support of scientific research.
I Both
authors: Samaritan Health Center, 5555 Conner Ave., Detroit, Ml 48213. Address reprint requests to D. L. Novak.
AJR 152:870-872,

AprIl 1989 0361-803X/89/1524-0870

C American Roentgen Ray society

that would

give

DIGITAL

AJR:152, April 1989

Fig. l.-Digft
Radiography.

suitable for use In Digital

Fig. 2.-Radiograph

RADIOGRAPHY

suitable

for use

871

in Digital Ra-

diography.

FIg.

3.-Digital

Radiography

In

actlonl

Measurement
of dimension
of lesion. This
developed while patient was traveling in a
foreign country, France. This is an example
of a French Foreign LesIon.

_:iI
=-

IIH
12.1
A
Fig. 4.-Technique

of calIbration.

Note that

fingertip
(Tipitus
TermInus
DIgitalIs)
Is even
with 1-in. mark, whereas
crease of firat knuckle

joint (Jointus Knucklus

cranes point.

are well aware,

Numero

FIg. 5.-A,
one fingers
B, Correct

B
Improper
use of digftal technique
worth.
use of digital technique
to request

in lay use. This is an incorrect

one fingers

method for requesting

worth.

Uno) is at ref-

rulers have a half-life on the reading bench of

3.5 days. The cause of disappearance

of rulers has been
speculated
on, but no satisfying
explanation
has come forth.
Be that as it may, which it will, replacement
of rulers can be
a major item in the expense budget of radiology
departments.
For example,
in a department
with 1 0 film-reading
stations,
if
all rulers were replaced
immediately
on disappearance,
the
department
would need i ,042.85 new rulers a year. With the

digital

system,

this expense

is avoided.

Another

advantage

is

the ever-present
aspect of the device. Even those rulers that
do not spontaneously
disappear are frequently
mislaid and
unavailable for use when needed. However, the digital system
is constantly
present;
right, and there it is.

one need

only

go to the elbow,

turn

There are some disadvantages

to the system, to be sure.
First of all, the technique must be standardized
as described

NOVAK

872

above. One cannot use the width of a digit, as is often done

in lay use. For example,
liquid libation
is often ordered
by

reference to a form of digital measurement

(Give me one
fingers worth!) [3] (Fig. 5A). In true digital measurements,
one fingers worth (3 KUs or 1 FKU) would be considerably
more (Fig. 5B)!
During physical

obvious

Also to be considered

reasons,

certain

body

parts

are mea-

the fingernail

is the fingernail

length

length.

is not included

method.
Measurements
are made from the tip of the
finger pad (Tipitus Terminus
Digitalis) to the first knuckle joint
(Jointus Knucklus
Numero Uno) (Fig. 4).

Certainly,

this article does not investigate

of advantages
of the
viously further investigation

fully the multiplic-

Digital Radiographic
method.
Obis indicated,
and to this end we

urge others to institute aggressive

knowledge to this most important

AJR:152, April 1989

REFERENCES
1 . Brody WR. Digital radiography.
New York: Raven Press, 1984
2. Frustrated
IM. Personal communication.
(No longer available because

of

cutbacks to ease the federal budget deficit)

3. Fields WC.

5.

A gentlemans
guide to spirits and etiquette.
Los Angeles, CA:
Boozer & Co, 1933
Other references,
such as previous employers, avwlabie on request
CredIt Reference: Credit Bureau of America, 435 W. Madison Ave., New
York, NY

For

in the

DDM

ity

BATES

4.

examination,

sured by finger breadth (e.g., liver three fingerbreadths

below
costal margin). However, this is specifically a finger-breadth
measurement
and is so stated. The term fingerbreadths
should never be used in Digital Radiography,
in order to avoid
confusion.

AND

research programs to add

area of radiologic practice.

Editors note. Dr. M. M. Figley explained the origin of April Fools

Day quite eloquently in a previous issue (MR 1984;142:845):
On
April Fools Day, April 1, it is considered appropriate to tell lies and
play practicaljokes
on the unwary. This day, also known as All Fools
Day, is observed
almost universally throughout the Western world.
The custom is thought to have begun in France, where formal
visits
were paid to friends on the first day of April, which was 1 week after
New Veers
Day (March
25 under the Old Style Gregorian calendar).
When New Years Day was moved to January 1 in 1752, mock calls
continued

to be paid

on April

1 as a joke.