title: The utility of plain radiography in assessment of upper aerodigestive tract fishbone impaction: an evaluation of 22 New Zealand fish species.
abstract: OBJECTIVE
  To determine the utility of plain radiography for suspected upper aerodigestive tract fishbone impaction in New Zealand fish species.
  
  
  METHODS
  Tissue densities of the least and most dense regions of the upper aerodigestive tract were measured on a lateral soft tissue X-ray of the neck. Densities of the measured regions were reproduced in two custom manufactured radiological phantoms. Epipleural bones from 22 commonly eaten New Zealand fish species were X-rayed within these phantoms. Forty-one Emergency Department doctors graded the X-ray visibility of each bone using a five point visual analogue scale.
  
  
  RESULTS
  Twenty species (90.9%) returned a sensitivity of 95% or greater when viewed within the least dense phantom. The two species with lesser sensitivities within the least dense phantom were Red Cod (90.2%) and Ray's Bream (58.8%). Only one species (Black Cardinalfish; 4.5%) returned a sensitivity of 95% or greater when viewed within the most dense phantom.
  
  
  CONCLUSIONS
  Bones from the majority of commonly eaten New Zealand fish species are poorly visible when X-rayed in a background of soft tissue density. Given fishbones frequently impact in regions of high tissue density, plain radiography would appear insufficiently sensitive to exclude upper aerodigestive tract fishbone impaction.
authors.affiliation: Emergency Department, Starship Children's Hospital, Auckland.
authors.forename: Tim
authors.initials: T
authors.lastname: Ritchie
authors.forename: Martyn
authors.initials: M
authors.lastname: Harvey
mesh_terms: D000818:Animals; D003937:Diagnosis, Differential; D004947:Esophagus / Q000000981:diagnostic imaging*; D005399:Fishes; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D009520:New Zealand; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012137:Respiratory System / Q000000981:diagnostic imaging*