Radiographic Equipment and Accessories as a Potential Source of Nosocomial Infection

Background: Nosocomial infections have become a major challenge in healthcare facilities as they affect the quality of medical care. Radiological imaging plays a crucial role in medical diagnosis. However, the equipment and accessories used increase the risk of transmission of nosocomial bacteria. Objective: This study aims to reveal the extent and nature of microbiological contamination in four hospital diagnostic imaging departments to determine their potential role in the spread of nosocomial bacteria and to evaluate the effectiveness of routine daily disinfection practices in controlling microorganisms in diagnostic imaging departments. Methods & Results: In each department, swabs were taken from the surfaces of selected parts of the equipment and accessories three times a day (early morning, noon, and evening) for five consecutive days. Bacteria were isolated from 65 swabs (36.1% of all samples). The bacteria were isolated 3 times (4.6%) in the morning, 16 times (24.6%) at midday, and 46 times (70.7%) in the evening. The bacteria isolated were Escherichia coli (isolated 34 times;52.3%), Staphylococcus aureus (20 times;30.8%), Staphylococcus epidermidis (6 times;9.3%), and Klebsiella species (5 times;7.7%). Discussion & Conclusion: Findings demonstrated that radiology equipment and accessories are not free of bacteria and further improvements in the sterilization and disinfection of radiology equipment and accessories are needed to protect staff and patients from nosocomial infections.

HIPPO artificial intelligence:Correlating automated radiographic femoroacetabular measurements with patient-reported outcomes in developmental hip dysplasia

BACKGROUND Hip dysplasia(HD)is characterized by insufficient acetabular coverage of the femoral head,leading to a predisposition for osteoarthritis.While radiographic measurements such as the lateral center edge angle(LCEA)and Tönnis angle are essential in evaluating HD severity,patient-reported outcome measures(PROMs)offer insights into the subjective health impact on patients.AIM To investigate the correlations between machine-learning automated and manual radiographic measurements of HD and PROMs with the hypothesis that artificial intelligence(AI)-generated HD measurements indicating less severe dysplasia correlate with better PROMs.METHODS Retrospective study evaluating 256 hips from 130 HD patients from a hip preservation clinic database.Manual and AI-derived radiographic measurements were collected and PROMs such as the Harris hip score(HHS),international hip outcome tool(iHOT-12),short form(SF)12(SF-12),and Visual Analogue Scale of the European Quality of Life Group survey were correlated using Spearman's rank-order correlation.RESULTS The median patient age was 28.6 years(range 15.7-62.3 years)with 82.3%of patients being women and 17.7%being men.The median interpretation time for manual readers and AI ranged between 4-12 minutes per patient and 31 seconds,respectively.Manual measurements exhibited weak correlations with HHS,including LCEA(r=0.18)and Tönnis angle(r=-0.24).AI-derived metrics showed similar weak correlations,with the most significant being Caput-Collum-Diaphyseal(CCD)with iHOT-12 at r=-0.25(P=0.042)and CCD with SF-12 at r=0.25(P=0.048).Other measured correlations were not significant(P>0.05).CONCLUSION This study suggests AI can aid in HD assessment,but weak PROM correlations highlight their continued importance in predicting subjective health and outcomes,complementing AI-derived measurements in HD management.

Radiographic and magnetic resonances contrast agents:Essentials and tips for safe practices

With extended and continued expansion of medical imaging utilization in modern medical practice over last decade, radiologists as well as other faculty staff dealing with radiographic and magnetic resonances contrast media(CM) have to be well oriented with their potential hypersensitivity reactions and recognize high-risk groups liable to develop it so as to enable early recognition. Radiologists and other medical staff involved in administration and dealing with CM have to be ready to implement prompt, practical and effective management plan to deal with these scenarios should they emerge. Strategies to prevent potential contrastinduced acute and delayed renal injuries have to be routinely exercised. Paying attention to the pregnant and nursing women, pediatrics, diabetics, as well as other fragile populations is of utmost importance for patient safety during contrast administrations. Radiologists should play a pivotal role in orienting patients about necessity to use CM for their imaging studies, in case it is needed, and assure them about its safety. Moreover, they have to be oriented with the medico-legal issues related to use of CM. These will pay as improved patient safety as well as safe daily working environmentat different levels of radiology practices.

Intracolonic multiple pebbles in young adults:Radiographic imaging and conventional approach to a case

Most of the foreign bodies detected in adult gastroin- testinal systems are accidentally swallowed pins. In this study, we presented a case with intracolonic multiple pebbles. A 20-year-old man was admitted to emergency surgery policlinic for abdominal pain for 2 d without any alleviation or aggravation. His upright plain abdominal radiographic imaging revealed about 30-40 overt dense opacities in lumen of colonic segments, with oval and well shaped contours, each approximately 1 cm × 1 cm in size. The multiplanar reconstructions and three- dimensional images combined with sectional screening showed that all pebbles had passed completely into the colon and no foreign bodies had remained in the ileal segments. On psychiatric assessment, he was found to have immature personality features, difficulty in over- coming stressors and adaptation disorder. He recovered by conservative management and radiographic monitoring applied during his follow-up. Thus, it can be concluded that, in differential diagnosis of abdominal pain in adult ages, though less frequently seen than in children, gastrointestinal system foreign bodies should always be kept in mind and it should be considered that ingestion of pebbles may be one of the factors contributing to abdominal pain particularly in young adults with psychiatric problems. In such cases suspected of having foreign bodies which cannot be detected by plain films, abdominal tomography can be an alternative for diagnostic imaging.

A Retrospective Study of Radiographic Anatomy of Wrist in Chinese Population

In wrist pathology, there is a need to establish the normal range of radiographic measurement parameters. Previous study showed that the contralateral wrist might not be valid as a reference for all parameters. There is a lack of literature describing the normal range of wrist radiographic parameters in literature. As a result, a retrospective study was carried out. Patients who underwent standard wrist x-rays during the period February 2012 to February 2013 (one single year) were retrospectively reviewed. 71 patients were included. Scapholunate angle was 54.7° (±6.5°). Scapholunate interval was 2.0 mm (±0.4 mm). Ulnar variance was +1.0 mm (±1.8 mm). Carpal height was 31.8 mm (±3.0 mm). Radial inclination was 25.1° (±2.1°). All 71 patients had 1 sesamoid bone at first metacarpal. 16.9% (12 out of 71) patients had positive cortical ring signs. All these parameters are valuable clinically, especially in monitoring of the wrist disease progression, in the design of wrist implants and for future clinical research.

Natural course of ovarian torsion after untwisting: A case report with radiographic imaging

Background: Radiographic studies largely contribute to prompt diagnosis of ovarian torsion, though post-operative changes are not described and might contribute to unnecessary intervention. Case: We report a case of ovarian torsion diagnosed based on clinical presentation and radiographic findings. The detorsion was successfully performed through laparosopic access. Subsequently patient presented for elective ultrasonography and MRI which diagnosed multicystic ovarian mass, attributed to hematoma which resolved spontaneously with no intervention in 3 weeks. Conclusion: Ovarian changes after detorsion consistent with development of hematoma may be benign and resolve spontaneously.

Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis

AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-na?ve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.

C-reactive protein and radiographic findings of lower respiratory tract infection in infants

AIM To evaluate the association between C-reactive protein(CRP) and radiological evidence of lower respiratory tract infection(LRTI) in infants.METHODS All patients aged less than 4 years who presented with suspected lower respiratory tract infection,who received a peri-presentation chest radiograph and CRP blood measurement over an 18-mo period were included in the study.Age,gender,source of referral,CRP,white cell count,neutrophil count along with the patients' symptoms and radiologist's report were recorded.RESULTS Three hundred and eleven patients met the inclusioncriteria.Abnormal chest radiographs were more common in patients with elevated CRP levels(P < 0.01).Radiologic signs of LRTI were identified in 73.7% of chest radiographs when a patient had a CRP level between 50-99 mg/L.CRP levels were a better predictor of positive chest radiograph findings for those aged greater than I year compared to those 1 year or less.CONCLUSION CRP may be used in patients with suspected LRTI diagnosis to select those who are likely to have positive findings on chest radiograph,thus reducing unnecessary chest radiographs.

Skeletal dysplasias: A radiographic approach and review of common non-lethal skeletal dysplasias

Skeletal dysplasias are not uncommon entities and a radiologist is likely to encounter a suspected case of dysplasia in his practice. The correct and early diagnosis of dysplasia is important for management of complications and for future genetic counselling. While there is an exhaustive classification system on dysplasias, it is important to be familiar with the radiological features of common dysplasias. In this article, we enumerate a radiographic approach to skeletal dysplasias, describe the essential as well as differentiating features of common non-lethal skeletal dysplasias and conclude by presenting working algorithms to either definitively diagnose a particular dysplasia or suggest the most likely differential diagnoses to the referring clinician and thus direct further workup of the patient.

5-year audit of the range and volume of diagnostic radiographic services at the University of Nairobi Dental Hospital

Background: Dental and cranio-maxillofacial diagnostic imaging constitutes an invaluable tool in the accurate diagnosis and management of a diverse range of conditions and diseases that afflict the oral and cranio-maxillofacial region. In order to improve on any existing facility, periodic audit evaluation is paramount. In this way proper and relevant service delivery can be achieved. Objective: To evaluate the range and volume of dental and cranio-maxillofacial diagnostic radiographic services offered at the University of Nairobi Dental Hospital (UNDH) in Kenya over a 5-year period (2006-2010). Methods: Retro-spective survey involving manual examination of patient records at the Division of Dental and cra-nio-maxillofacial Radiology registry of the UNDH. Results: Over the study period, the range of diagnostic radiographic services offered comprised of both intra- and extra- oral examinations. The total volume of radiographs taken was 48,874 among which 41,980 (86%) were intraoral and 6894 (14%) extraoral views. Among the intraoral views, 74% were bitewing, 25% periapical and only 1% were occlusal diagnostic views. The majority (95%) of the extraoral projections consisted of panoramic views and only 5% constituted other techniques. The volume of radiographs was high from January to September while November and December had the lowest number of examination requests. Conclusion: Intraoral radiography was the commonest examination with bitewings having been the majority while the panoramic tomography was the commonest extraoral examination performed.

Radiation Field Preference for Radiographic Anatomical Markers by Radiographers in a University Teaching Hospital in Nigeria

Objective: The work aims to determine the radiographers’ preference between primary and secondary radiation fields for imprinting anatomical markers on radiographs. Methodology: Processed radiographs from the darkroom with evidence of radiographic anatomical markings were selected randomly and reviewed using a viewing box, within a 4-week period. The radiation field in which markers were placed was noted for each radiograph. Faintly-appearing and partly coned- off markers were excluded. Simple statistical tools were used to derive central tendency. Result: 623 radiographs were assessed. 89.0% (n = 555) had markers in the primary radiation field while 11.0% (n = 68) were in the secondary radiation field. 98% (n = 611) of markers did not obstruct essential anatomy while 2% (n = 12) did, but the radiographs were neither repeated nor rejected because of the twin reason of reportability and the need to avoid additional radiation dose to patients. Conclusion: Radiographers in the centre preferred the primary radiation field for marker placement to avoid cone-off, cut-off and illegibility which leads to repeat. This, however, does not offer superior advantage to markers placed in secondary radiation field. It is recommended that marker placement preference should be guided by the need for legibility, aesthetics and avoidance of essential anatomy.

Radiography of Clavicle Fractures— A Review of the Literature —Do Various Radiographic Views of Clavicle Fractures Affect the Management Plan?

Introduction: Fractures of the clavicle are common and make up 5% - 10% of all fractures. Treatment options in part depend on the location of the fracture along the bone and degree of displacement. These two parameters are best determined by good quality, standardized radiographs of the clavicle. We reviewed the literature to determine the optimal radiographs of clavicle fractures and their influence on the treatment plan. Methods: A comprehensive search of Medline? database was undertaken with the following search terms and MeSH headings: clavicle, fractures, bone, radiography, and X-ray. We included articles in English published from 1950 to present. We ruled out fractures in children, fracture dislocations, open fractures, those with neurological and vascular injuries and fractures involving the acromioclavicular or sternoclavicular joints. Findings: Of the 821 citations obtained, only four studies proved eligible. In the most pertinent, four orthopaedic surgeons were shown standard views (antero-posterior and 20&#176;cephalic tilt) of 50 clavicle fractures and then additional two views (45&#176;cephalic and caudal tilt), and found that alternative views influenced their decision making, with more surgeons opting for surgical fixation. In a different study, it was shown that orthogonal views of the clavicle increased surgeons’ understanding and improved their treatment of these fractures. The third paper was a case series on clavicle fractures that were missed on the initial antero-posterior radiograph, and the fourth paper postulated that postero-anterior views of the thorax were most accurate in determining length of the clavicle. Conclusion: Studies showing an optimal view for assessment of clavicle fractures with a decision to then progressing to operative fixation are few, but the evidence points towards surgical fixation when alternative views of mid-shaft clavicle fractures are present.

Extra-Oral Digital Panoramic Radiographic Interpretation and Clinical Findings of Stage IV Periodontitis among Some Samples Concerning Saudi/Non-Saudi Nationality

Background: There are associations between the severity of periodontal diseases and some predisposing factors, such as age, race, and income rate. Therefore, the present study was designed to evaluate the extra-oral digital panoramic radiographic interpretation and clinical findings of stage IV periodontitis among some samples concerning Saudi/non-Saudi nationality. Material and Methods: The study comprised a random sample of 298 residents in Saudi Arabia referred to the internship program clinics at the College of Dentistry, King Khalid University. They were according to the age of participants as follows: youth (15 - 24 years), adults (25 - 64 years), and seniors (65 years and over) within two groups according to nationality (Saudi and non-Saudi). Clinical periodontal examination and radiographic extra oral digital panoramic radiographs were done, and then the periodontal parameters, the percentage of bone loss, and the pattern of bone loss were recorded. The data was collected, and the statistical analysis was performed with ANOVA test, Tukey’s test, Chi-square test, and T-test and considered a P-value at (p Results: The samples included 62 (20%) youth participants with mean of age (21.806 ± 3.390), 182 (57%) adults’ participants with mean age (42.802 ± 9.094), and 54 (23%) seniors participants with a mean age (69.074 ± 6.810). There were highly statistically significant differences in the comparison between the participants’ ages (P 0.05). Conclusion: At the end of this study, we concluded that there are alterations in clinical and radiographic and clinical findings of stage IV periodontitis with the alteration of participants’ ages and nationality.

Morphologic,Radiographic,and Stereomicroscopic Evaluation of Teeth Subjected to High Temperatures:An In vitro Forensic Study

Background:To evaluate morphologic,radiographic,and stereomicroscopic changes of teeth when subjected to specific high temperatures in both direct heat and gradual heat and to compare the changes among two heat groups and also among different types of teeth.Materials and Methods:An in vitro study was conducted on 90 healthy extracted human teeth,in which the teeth were divided into two groups.Group 1(45)was subjected to direct heat and Group 2(45)was subjected to gradual heat.Group 1 and Group 2 were further subdivided into three subgroups(A)anteriors,(B)premolars,and(C)molars each consisting of 15 teeth.Teeth were subjected to temperatures of 200°C,400°C,600°C,800°C,and 1000°C in a muffle electric furnace.The color changes were noted using the Revised Munsell soil color chart and the radiographic and stereomicroscopic changes were evaluated.The results obtained were subjected to statistical analysis.Results:Teeth in direct heat showed more destructive changes at lower temperatures,i.e.,400°C and 600°C when compared to gradual heat where changes are observed at 600°C and 800°C.Among different types of teeth,anteriors and premolars showed more changes when compared to molars.Interpretation and Conclusion:It can be concluded that dental evidence may provide clues to solve the mystery in fire investigations as dental structures are the last to be destroyed under extreme conditions,whether temperature,acid,or putrefaction.

Radiographic Measurement of Femoral Lateral Bowing and Distal Femoral Condyle Resection Thickness： Variances and Effects on Total Knee Arthroplasty Planning

Background：Accurate evaluation of the plain radiography of lower limb is critical for preoperative planning of total knee arthroplasty （TKA）. We aimed to investigate the effect of femoral lateral bowing and rotation on the radiographic measurements of distal femoral condyle resection thickness （DRT） and the distal femoral resection valgus angle （FVA）. Methods： We analyzed 246 three-dimensional femoral models generated from computed tomography images of 123 patients, acquiring projected contours in seven positions – 20° and 10° internal rotation; 0° rotation; 10°, 20°, 30°, and 40° external rotation – for each model. Medial and lateral condyle DRTs, femoral shaft lateral bowing angle （FBA）, and distal FVA were determined for each position. Linear mixed effect model was used to determine the effect of degree of femur rotation on repeated measurements of DRT or FVA. Results： FBA significantly affected the FVA and DRT （Pearson＇s R = 0.767 and -0.408, respectively; P 〈 0.000）. Samples were divided into three groups according to the FBA measured in neutral position： FBA 〈0°： DRT 3.75 ± 1.30 mm, FVA 4.53° ± 1.27°; FBA 〉0° but 〈3°： DRT 3.39 ± 1.31 mm, FVA 5.92° ± 1.31°; FBA 〉3°： DRT 2.22 ± 1.31 mm, FVA 7.37° ± 1.31°. From simulated 20° internal rotation to 40° external rotation in each femoral model, the average variation ranges of radiographically measured DRT, FVA, and FBA were 0.50 ± 0.28 mm, 2.93° ± 0.96°, and 10.33° ± 1.90°, respectively, with no significant differences among the FBA groups. The degree of femoral rotation significantly affected the FVA （F = 62.148, P 〈 0.000）, whereas there was no effect on condyle resection thickness （F = 0.4705, P = 0.494）. Conclusions： Axial femoral rotation has less effect on radiographic measurements of differences in the DRT than on those of the distal FVA.

RADIOGRAPHIC MEASUREMENT OF THE PREVERTEBRAL SOFT TISSUE OF CERVICAL VERTEBRAE

The radiographic measurement of the prevertebral soft tissue of cervical vertebrae was performed in 87 normal adults. According to the results of the measurement, 10 mm and 20 mm were used as the upper limit normal values of the retropharyngeal and retrotracheal space respectively. We conclude that although the widened soft tissue space is of diagnostic significance, diagnosis should be made on the basis of analysis of the injury history, clinical manifestation and imaging examination.

Radiographical evaluation of ulcerative colitis

Radiographical modalities have become important diagnostic tools in cases of ulcerative colitis(UC).Imaging can be used non-invasively to determine the extent of involvement,severity of disease and to detect disease-related complications and extra-intestinal inflammatory bowel disease(IBD)manifestations.While abdominal X-rays and barium enemas still retain their relevance in specific clinical settings,the use of computed tomography enterography(CTE)or magnetic resonance enterography(MRE)are now used as first-line investigations to exclude active small bowel disease in IBD patients and can be utilized to detect active colonic inflammation.Additionally,CT colonography and MR colonography are emerging techniques with potential applications in UC.Ultrasonography,leukocyte scintigraphy and positron emission tomography are novel abdominal imaging modalities currently being explored for IBD interrogations.This plethora of radiological imaging options has become a vital component of UC assessments.

Relationship between symptoms and weight-bearing radiographic parameters of idiopathic flexible flatfoot in children

Background Idiopathic flexible flatfoot in children most frequently improves with age and remains asymptomatic. It is a physiological variation of the normality that does not require treatment unless it becomes symptomatic. The aim of this research was to investigate the reason why some individuals with flexible flatfoot become symptomatic by analysis of the differences in the relative alignment of each segment of the foot between symptomatic and asymptomatic patients with idiopathic flexible flatfoot using radiographic measurements. Methods One hundred patients with idiopathic flexible flatfoot were retrospectively identified and divided into two groups： asymptomatic （n=50） and symptomatic （n=50）. Standing anteroposterior and lateral radiographs of the foot were analyzed. Five measurements were calculated to describe the alignment of the foot. An independent-samples t-test and Logistic regression test were used for statistical analysis. Results Age and sex were similar in the two groups. The independent-samples test revealed significant differences in two parameters： the anteroposterior talonavicular coverage angle and the lateral talo-first metatarsal angle. When the Logistic regression test was performed, only the talonavicular coverage angle showed statistical significance. Conclusions The lateral displacement of the navicular bone, measured by the anteroposterior talonavicular coverage angle, seems to be related to the onset of symptoms. In individuals with otherwise normal flexible flatfoot, an increase in this angle might be an important risk factor for developing symptoms.

Evaluation of Radiographic Diagnosis on Osteoarthrosis of the Temporomandibular Joint.

Eight-four cadaver specimens of temporomandibular joint were used for the comparison of the results shown in standard lateral tomographs and Shuller’s position films with the macroscoopic observations on the bone and cartilage changes. The results and conclusions were as follows: 1. The