Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2011. / BACKGROUND: Plain film radiography is the most common imaging technique requested by chiropractors to assist in the management of patients with musculoskeletal complaints. There is a paucity literature indicating that chiropractors’ interpretive radiographic skills are consistently able to achieve the same outcome given a particular set of radiographs. An important indication for the use of radiography in chiropractic is to exclude any possible contraindications to spinal manipulative therapy (SMT) that could cause serious injury to a patient if it is left unmodified or excluded as a treatment option. OBJECTIVES: The study aimed to investigate the inter- and intra-examiner reliability of chiropractor’s diagnosis on cervical spine radiographs. Additionally, the effect of clinical history added to the radiographs was assessed. METHODS: Inter- and intra-examiner evaluations occurred on two consecutive readings of 30 radiographs by six qualified chiropractors. No clinical history was given during Round One, but was available during Round Two. RESULTS: The inter-observer agreement for categorisation and management went from “poor agreement” in Round One (Κ=0.1962 and Κ=0.1996 respectively) to “fair agreement” (Κ= 0.2041 and Κ=0.2036 respectively) beyond that expected by chance in Round Two. Identification remained “fair agreement” beyond that expected by chance over both rounds (Κ=0.3113 and Κ=0.2159). Sensitivity at Round One was 94.4% and the specificity was 61.1%. At Round Two the sensitivity had decreased to 93.8% and the specificity had decreased to 50%. There was no significant difference between the accuracy of the Round One and Round Two results for categorisation (p=0.243) and management (p=0.220), but there was a clinical difference for identification (p=0.014). iii CONCLUSION: Differences in the result were small indicating clinical relevance with regards to inter-examiner reliability was fair in most instances. Although clinical history did not influence categorisation or management, it did improve accuracy of identification of pathology. Chiropractors successfully identified between 93.8% and 94.4% of abnormal radiographic findings demonstrating that chiropractors use of radiographs as a diagnostic tool when looking for contraindications to spinal manipulative therapy was sensitive. This demonstrates that its use as a diagnostic tool for contraindications to spinal manipulative therapy (SMT) is sensitive.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background: Attempts to determine the association between the radiographic and clinical findings of knee pathology have produced conflicting results. It is also not yet known how knee radiographs influence the conservative management of patients with knee pain. Objectives: 1. To determine the association between the clinical and radiographic diagnoses of knee pain. 2. To record the consultation at which a radiograph of the knee was requested by the student or clinician and the reasons thereof. 3. To record the suspected clinical diagnoses and management of the patients prior to referral for radiographs of the knee. 4. To determine the number of incidental radiographic findings in the selected radiographs. 5. To determine any change in the clinical diagnoses and management following radiographic reporting of the selected radiographs. Method: Radiographic and clinical data from 1 January 1997 to 31 December 2010 were retrospectively collected from knee radiographs and corresponding patient files from the archives of the Chiropractic Day Clinic (CDC). Statistical analysis included the use of percentages, mean, standard deviation, range and frequency counts for the descriptive objectives. Diagnoses were categorized into specific groups and to construct two-by-two tables of absence or presence of radiographic vs. clinical diagnosis for each specific diagnosis to determine the association indicator variables were used. Results: The overall agreement between the clinical and radiographic diagnoses was 85.5%. For degenerative joint disease there was a 97.8% agreement while in Osgood Schlatter’s disease the agreement was 100%, and in chondromalacia patella the agreement was 50%. However, there was no agreement between the clinical and radiographic diagnoses for each of the other specific conditions. Degenerative changes were the most common radiographic findings. The iv majority of the knee radiographs were requested at the initial consultation and as the length of treatment increased, the frequency of radiograph requests decreased. The most common reasons for referral for radiographs were to identify degenerative changes (47.5%) and to assess for unspecified pathology (37.4%). Of the 146 patients in this study, 125 patients did not have a change in diagnosis after radiographs were obtained which means that 85.6% of the diagnoses remained the same after radiographic examination. There was a wide range of treatment modalities utilized in the management of patients with knee pain, including soft tissue therapy, electrotherapeutic modalities and manual therapy (manipulation and mobilization). The use of manual therapy increased from 67.8% prior to radiographs being taken to 82.9% after radiographs were obtained. Conclusion: Knee radiographs were over-utilized at the CDC and the findings on radiography did not have much influence on the diagnosis and the management of the patient presenting with knee pain. The majority of the clinical diagnoses were degenerative causes of knee pain. / Durban University of Technology Research Fund

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A Varian 4 MeV isocentric therapy accelerator has been modified to perform also as a CT scanner. The goal is to provide low cost computed tomography capability for use in radiotherapy. The system will have three principal uses. These are (i) to provide 2- and 3-dimensional maps of electron density distribution for CT assisted therapy planning, (ii) to aid in patient set up by providing sectional views of the treatment volume and high contrast scout-mode verification images and (iii) to provide a means for periodically checking the patients anatomical conformation against what was used to generate the original therapy plan. The treatment machine was modified by mounting an array of detectors on a frame bolted to the counter weight end of the gantry in such a manner as to define a 'third generation' CT Scanner geometry. The data gathering is controlled by a Z-80 based microcomputer system which transfers the x-ray transmission data to a general purpose PDP 11/34 for processing. There a series of calibration processes and a logarithmic conversion are performed to get projection data. After reordering the projection data to an equivalent parallel beam sinogram format a convolution algorithm is employed to construct the image from the equivalent parallel projection data. Results of phantom studies have shown a spatial resolution of 2.6 mm and an electron density discrimination of less than 1% which are sufficiently good for accurate therapy planning. Results also show that the system is linear to within the precision of our measurement (≈ .75%) over a wide range of electron densities corresponding to those found in body tissues. Animal and human images are also presented to demonstrate that the system's imaging capability is sufficient to allow the necessary visualization of anatomy.

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A study has been carried out to investigate the use of "real-time" radiography as a method of automated inspection of through-hole electronic circuit board solder joints. By evaluating five major solder defects it has been found that film radiography employing high contrast film results in a definite distinction between a good solder joint and a defective solder joint. The same five defects were also found to be distinguishable from a good solder joint when evaluated by a real-time radiographic inspection unit using digital image processing. Although the type of defect being investigated was not discernible, the ability to distinguish a good solder joint from a defective solder joint is a major step in the implementation of automated solder joint inspection for military electronics.

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