There were 15 dressings altogether in the study.
A skeletal hand (real bone) was placed on a clinical glove filled with water to mimic soft tissue density.
Photographs were taken of each dressing overlying the hand as well of X-ray images taken of each to demonstrate the degree of interference the presence of a particular dressing can have on assessing the presence of osteomyelitis.
Photographs and images are labelled as shown.
Figure 1 details the different dressing types and their descriptions.
Each one was given a numerical identifier from 1 to 15 to make annotation of the images easier.
It was aimed to demonstrate first of all how the dressings can be exposed on an X-ray.
The dressings laid out on an X-ray plate are shown in a photograph in figure 2.
They were then X-rayed in figure 3.
As can be seen,
many of the dressings are visible on X-ray but especially dressings number 4,
7 and 8.
A hand of real bone was used,
overlain on a latex glove filled with saline,
to mimic the effect of bone and soft tissue in a patient.
This is shown in figure 4.
We took a control X-ray to demonstrate an X-ray without dressings.
This is shown in figure 5.
Each dressing was then overlain on the hand as show in figures 6-8.
Dressings larger than 5cm x 5cm were lain over the metacarpal bones,
whilst those smaller were generally lain over the 4th and 5th proximal and middle phalanges.
Figure 6 shows dressing 1,
figure 7 dressing 2 and figure 8 a smaller dressing,
dressing 3.
Each X-ray image was taken under the same conditions,
at 60kV,
0,63mAs.
On review of the images,
images were selected where the dressing on the radiograph overlying the bone could be seen.
Most notably these images were of dressings number 5,
7 and 8.
The images were windowed,
as they would be in real life when reporting to detect very subtle changes in the bone density.
These were annotated to show how they were obscuring the bone.
Figure 9 shows dressing 5 overlying the hand on the 4th and 5th middle phalanges.
This is a 5cmx5cm Inadine Dressing by Systagenix and is impregnated with Iodine.
Red arrows delineate the corners of the dressing clearly visualised in figure 10,
the standard view,
and figure 11,
the windowed view,
where the dressing is much more apparent.
Figure 12 shows dressing 7 on the hand model.
This is an Aquacel Dressing by Convatec.
In this case it was placed between the 3rd and 4th middle phalanges as this dressing is designed with hydrofibre technology to be folded within ulcers.
It is clearly shown by the arrows without windowing in figure 13.
Figure 14 shows dressing number 8 overlying the hand.
This is an Allevyn Ag Gentle Border Classic dressing by Smith and Nephew,
containing silver sulfadiazine silicone and is by far the most noticeable dressing.
Figure 15 is the unwindowed view and figure 16th is windowed.
The 2 arrows show the pad of the dressing and the adhesive section clearly.