Professional Documents
Culture Documents
X-Ray
Gogs:
New
David
K. Edwards
1111
Imaging
Preliminary
Modality
Evaluation
of a
uftrasound,
in evaluating
Conventional
techniques
were preferable
in terms of
quality, and are thus recommended
in most settings.
ionizing radiation,
X-Ray Gogs are recommended
in
indicated,
or where the results of radiographic
study
or where
the diagnosis
has already
been
GOGS.
You saw these advertised
in comic books as a child. And you
wanted them with all your heart. And your parents objected.
And you yielded.
And since then life has not been very happy for you, has it? We offer a second
chance to buy, own and operate the famous X-ray glasses. According
to the
package,
it is: the scientific
marvel of the century.
Not sold to communist
countries
on the restricted
list that also prohibits
sales of Cray Supercomputers. $1 .25 each.
Quoted with permission
from [1]
X-RAY
and
in imaging techniques,
it was mildly surprising
to
and to realize that X-Ray Gogs (XRG), which have
for many years, have evidently
not been examined
of parental skepticism
and parsimony,
the author
life was not riotously
happy thereafter.
However,
a
parents recalls that XRG permitted
visualization
of
the lead in a wooden pencil (Bobby Bubba
Young,
study was to compare
of clinical pediatric
settings.
XRG
with
conventional
Methods
The XRG as received from the vendor (Archie McPhee & Co., Seattle, WA) consisted of
plastic frames with cardboard
inserts
containing
5-mm
openings
in which
a red, translucent,
striated material acted as a lens (Fig. 1). The striated material proved to be part of a red
feather
Departments
of Radiology
and Pediatrics,
University of California
at San Diego Medical Center,
225 Dickinson
St., San Diego, CA 92103. Address
reprint requests
to D. K. Edwards
Ill.
AJR 150:731-734,
AprIl 1988
0361 -803X/88/1
504-0731
American
Roentgen
Ray Society
[3].
To
permit
a correct
interpupillary
distance
and
to
compensate
for
myopia,
removed the cardboard inserts and affixed them to prescription spectacles (Fig. 2).
A miscellaneous
variety of pediatric sonographic
(n = 30) and radiographic
(n = 97)
examinations (list available on persuasive request) were performed
with simultaneous
or nearsimultaneous
XRG observation. The bright light required
by the XRG studies was intermittently
turned on and offduring fluoroscopic procedures.
The Human
Subjects Committee responded to routine petition
manner that was interpreted as approval. Because of the benign
in an
uncouth,
jocular
informed consent was considered implicit. Pediatric patients (age, 1 day to 10 years) were
employed both because of the authors area of specialization and because adults, encountered in hallways, responded
adversely
to the examiners appearance
(Fig.
2), whereas
EDWARDS
732
AJR:150,
April 1988
Fig. 1.-Obverse
of X-Ray Gogs and
package
label, photographed
on corduroy
(5.5
ridges/cm).
Reverse
of
package label (not shown) contains instructions
and faintly distasteful
insinuations about seeing through clothing.
Fig. 2.-X-Ray
use with prescription
children
Gogs modified
lenses.
for
seemed
used
wherever
Results
Preliminary
Evaluations
Comparative
Study
Fig. 3.-Three
of the authors
fingers
viewed
through
X-Ray
Gogs.
X-RAY
AJR:150,
April1988
TABLE
1: ComparIson
of X-Ray
Gogs
and Conventional
Correct
Diagnosis
Conventional techniques
X-Ray Gogs
Significance of difference
Pathological,
b 30 sonograms
d
surgical, or clinical
not included.
GOGS
Radiographic
Image
Quality
Techniques
(127 Examinations)
The
s tudy in
preferred
Ease of
Examination
127
0
p < SC
112 (88%)
60 (47%)
p
tinyd
733
0
127
p < SC
terms of:
Cost of
Examination
Radiation
Dosen)
0
97
p < SC
0
127
p < SC
confirmation.
or thereabouts.
wrong in 61 cases,
while
and conventional
techniques
wrong
in 9 cases.
Using McNemars
test, the authors
IBM clone had difficulty calculating
the associated
p value. Suffice it to say that p is dazzlingly
small. Not to worry.
SC = smoking
computer:
the clone, using the sign testand attempting
to compute the infinitestimal
p values of chi-square
in the megaton
(100+)
began to smoke: heavily, indoors, and in defiance of localordinance
and several clearly visible signs.
Exemplary
Case Reports
Case 1.-A
4-year-old
girl presented
to the Emergency
Room with a hurt finger. The intern, swamped
with patients,
injudiciously
ordered radiographs
before examining
the child.
The finger proved to have been hurt by a bee sting.
X-Ray Gog Examination:
Soft-tissue
swelling dorsal to distal
phalanx. No bony injury seen.
Radiographic
Examination : Ditto.
Comment:
No imaging examination
was indicated.
Case 2.-A
3-year-boy
was evaluated
for unexplained
fever. Examination
revealed otitis media, purulent nasal discharge, and tenderness
over the left maxilla. The discharge
was sent for culture, and the patient was begun on antibiotics
and decongestants.
As the child was leaving the clinic, a
Waters view of the paranasal
sinuses
was requested
and
obtained.
X-Ray Gog Examination:
No abnormality
seen.
Radiographic
Examination : Radiopacity
of the left maxillary
antrum.
Comment:
The XRG diagnosis was clearly wrong. However, the clinicians proposed
to treat the child the same
whatever
the radiographic
study showed.
The film added
nothing except a nebulous entity called baseline.
Case 3.-A
1-month-old
boy presented
with projectile
vomiting.
Examination
revealed
mild dehydration,
peristaltic
waves across the upper abdomen,
and a palpable
mass
(olive)
in the right abdomen.
Sonography
demonstrated
a
lengthened
pyloris with a wall thickness
of 5.5 mm; pyloric
stenosis
was diagnosed.
However,
an upper gastrointestinal
series (UGI) was demanded
and, after unseemly shouting and
fieXings of ego on the part of the dinicians
and radiologists,
grudingly performed.
X-Ray Gog Examination : Barium sulfate suspension,
administered by bottle and nipple, was not seen to flow freely
through a normal esophagus.
The filled stomach
was not
observed
in several
projections.
Pyloric
lengthening
and
marked narrowing
(string sign) were not noted. Distal to the
narrowing,
a normal duodenal sweep and ligament of Trietz
were not appreciated.
Hypertrophic
pyloric stenosis was not
diagnosed.
Fluoroscopic
Examination:
Ditto, deleting
the word
not.
range,
Comment:
The diagnosis
of pylonc stenosis was established prior to further study, if not clinically then certainly
by
sonography.
The unnecessary
UGI cost $203 and inflicted an
active marrow radiation dose of perhaps 0.1 rad (0.001 Gy).
Discussion
Red goggles, long a radiologic mainstay until the development of image intensifiers,
are now useless save possibly for
staring at the superficial veins of breasts [5]; indeed, if tinted
goggles are to be worn, they probably
should be yellow, to
enhance depth perception
[6]. Breasts were not visualized in
the current study (although not for want of trying), and any
potential advantage
of XRG in maintaining
dark-adaptation
was vastly outweighed
by several painful collisions with both
fixed and animate objects.
The imaging ability of XRG, when judged by the limited,
picayune standards
of diagnostic
accuracy
and image quality,
is admittedly
abysmal.
Nonetheless,
this study suggests
a
definite role for XRG in the diagnostic imagers armamentarium. The modality
is invaluable
in the following
common
settings: (1) where radiography
is not indicated but someone
badly wants it anyhow; (2) where the results of radiographic
study will not influence
patient management;
and (3) where
the diagnosis has already been established
by other means
(i.e., The more times you run over a dead cat, the flatter it
gets. [7]).
It is recommended
that every radiologist
purchase
XRG
and modify them to his or her ocular needs. Then, when one
of these settings is encountered,
the radiologist should vigorously recommend
to the clinician an XRG examination
in
lieu of whatever
conventional
radiation-laden
and/or costly
study is requested.
This recommendation
may be enhanced
by slowly and portentiously
donning
the XRG, gazing
solemnly about, and finally stumbling
off in the general direction
of the patient. Then, having performed the XRG examination,
only one diagnosis
need be pronounced:
No abnormality
seen. The advantages
to the radiologist,
and especially to
the patient, are obvious.
However,
further investigation
supported by substantial
and tax-exempt
grants is needed (and
isnt it always?).
734
EDWARDS
ACKNOWLEDGMENTS
Gratitude is expressed to the unknown founder(s) of April Fools
Day; to the AJR editorial staff for helping commemorate
it; and to
Carol A. Edwards and Marcia L. Eamshaw
for their photographic
assistance.
AJR:150,
April1988
786-788
REFERENCES
1. Anonymous.
Catalog #5. Archie McPhee & Company, Box 30852, Seattle,
WA 98103, 1987:20
2. In other words, if X-Ray Gogs were previously
tested, the report is buried
somewhere
beyond reach of the authors
bibliographic
search service and
(one hopes) beyond reach of the readers memory as well.
3. Yes, a feather. I know little of matters avian, but my parents did provide a
childhood
toy microscope,
and I do know feathers.
X-Ray Gog barbicels
and hamull were clearly discernible
at 30X.
4. See any comprehensive
medical history text. Direct citation of Dr. Roentgen might imply that I read German,
or have read translations, which I
dont and havent. Give me a break.