Correlation of stress radiographs to injuries associated with lateral ankle instability

BACKGROUND Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability.AIM To determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability.METHODS A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed.These manual radiographic stress views were then correlated with magnetic resonance imaging and operative findings.RESULTS A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology(P=0.008 for tendonitis and P=0.020 for peroneal tendon tears).A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability(P=0.043).CONCLUSION Although valuable in the clinical evaluation of ankle instability,stress radiographs are not an independent predictor of conditions associated with ankle in-stability.

Fast and Low Cost X-Ray Stereoradiography Displayed on a 3D Monitor

Conventional x-ray stereoradiography based on film radiography is not practical due to its inconvenient and time-consuming procedures. In this research, an image viewing system consisted of a 30 cm × 30 cm gadolinium oxy-sulfide (GOS) fluorescent screen and a Cannon 500D digital camera were designed and constructed for real-time and near real-time x-ray imaging. The camera was connected to a laptop computer via USB port to allow remote camera setting and control as well as view image on the computer. The system was tested with x-rays generated from a Rigaku x-ray tube for its response at various camera settings and exposure times. The image brightness increased with increasing of the camera ISO setting and with the exposure time as expected. To test the system performance, two test specimens were radiographed including a video camera and a floppy disk drive as well as two simulated specimens. Each of the test specimens was also radiographed at two positions by moving the specimens approximately 6 cm from the first position. The two radiographs of each specimen were then combined to make an anaglyph image that could be viewed in 3D on a normal LCD or LED monitor by using appropriate color glasses. When the two radiographs were combined to make MPO (multiple object) file format, it could be viewed in 3D on a 3D monitor with or without 3D glasses depending on type of the monitor. The developed system could be conveniently employed for routine inspection of a specimen both in 2D and 3D within a minute.

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.

Transition to computed radiography： can emergency medicine doctors accurately predict the need of film printing to facilitate optimal patient care？

BACKGROUND： This study aimed to evaluate emergency medicine doctors＇ accuracy in predicting the need of film printing in a simulated setting of computed radiography and assess whether this can facilitate optimal patient care.METHODS： Cross sectional study was conducted from 20 March 2009 to 3 April 2009 in 1334 patients. After clinical assessment of those patients who needed X-ray examination, doctors in the emergency department would indicate whether film printing was necessary for subsequent patient care in a simulated computed radiography setting. The fi nal discharge plan was then retrieved from each patient record. Accuracy of doctors＇ prediction was calculated by comparing the initial request for radiographic film printing and the final need of film. Doctors with different level of emergency medicine experience would also be analyzed and compared.RESULTS： The sensitivity of predicting fi lm printing was 84.5% and the specifi city of predicting no fi lm printing was 91.2%. Positive predictive value was 88.4% while negative predictive value was 88.2%. The overall accuracy was 88.2%. The accuracy of doctors stratified into groups of fellows, higher trainees and basic trainees were 85.4%, 90.5% and 88.5% respectively （P=0.073）.CONCLUSIONS： Our study showed that doctors can reliably predict whether film printing is needed after clinical assessment of patients, before actual image viewing. Advanced indication for film printing at the time of imaging request for selected patients can save time for all parties with minimal wastage.

A Derived Exposure Chart for Computed Radiography in a Negroid Population

Background: Computed radiography has a wider exposure latitude when compared with film-screen imaging system. Consequently, the risk of dose creep is high. A conscientious effort is there-fore, needed by the radiographer to keep exposure as low as reasonably achievable. Objective: To derive a computed radiography exposure chart for a negroid population using AGFA photostimulable phosphor plates and a GE static X-ray machine. Materials and Method: A static X-ray machine, a digitizer, and photostimulable phosphor plates were used for the X-ray examination. Chest examinations were done at a Focus-Film-Distance (FFD) of 150 - 180 cm while all other examinations were conducted at 90 - 100 cm FFD. The range of exposure factors (kVp, mA and mAs) used by radiog-raphers in the centre was noted and the 90th percentile calculated. Over a three-month period, the patients were examined with the 90th percentile of tube potential (kVp) while keeping other factors constant. The kVp was gradually decreased and halted if radiologists and radiographers uncon-nected with the work expressed misgivings about the quality of the image. A similar procedure was adopted for the tube current (mA). The threshold adopted as low as reasonably achievable was the factor preceding the point of observation by other personnel. Metrics for central tendency from the statistical packages for social sciences, version 17.0 was used to analyze the data. Results: 335 subjects of both gender aged 0 - 92 years were examined by the researchers. Adult exposure factors used by the radiographers (and those derived by the researchers) had a range of 45 - 130 kVp (62 - 94 kVp), 63 - 320 mA (100 - 250 mA) and 4.0 - 25.0 mAs (5.0 - 20.0 mAs) respectively. Pediatric chest (and researchers-derived) factors were 50 - 75 kVp (52 - 65 kVp), 50 - 250 mA (100 - 220 mA) and 3.20 - 10.0 mAs (3.2 - 6.5 mAs) respectively. Conclusion: Upper threshold of adult (and paediatric) exposure factors in computed radiography with comparable equipment and accessories should not exceed 94 kVp (65 kVp), 250 mA (220 mA) and 20.0 mAs (6.5 mAs) respectively. The derived exposure chart is also adequate to address motion unsharpness in chest examinations.

X-ray detection of ingested non-metallic foreign bodies

AIM: To determine the utility of X-ray in identifying non-metallic foreign body(FB) and assess inter-radiologist agreement in identifying non-metal FB. METHODS: Focus groups of nurses, fellows, and attending physicians were conducted to determine commonly ingested objects suitable for inclusion. Twelve potentially ingested objects(clay, plastic bead, crayon, plastic ring, plastic army figure, glass bead, paperclip, drywall anchor, eraser, Lego?, plastic triangle toy, and barrette) were embedded in a gelatin slab placed on top of a water-equivalent phantom to simulate density of a child's abdomen. The items were selected due to wide availability and appropriate size for accidental pediatric ingestion. Plain radiography of the embedded FBs was obtained. Five experienced radiologists blinded to number and types of objects were asked to identify the FBs. The radiologist was first asked to count thenumber of items that were visible then to identify the shape of each item and describe it to a study investigator who recorded all responses. Overall inter-rater reliability was analyzed using percent agreement and κ coefficient. We calculated P value to assess the probability of error involved in accepting the κ value.RESULTS: Fourteen objects were radiographed including 12 original objects and 2 duplicates. The model's validity was supported by clear identification of a radiolucent paperclip as a positive control, and lack of identification of plastic beads(negative control) despite repeated inclusion. Each radiologist identified 7-9 of the 14 objects(mean 8, 67%). Six unique objects(50%) were identified by all radiologists and four unique objects(33%) were not identified by any radiologist(plastic bead, LegoTM, plastic triangle toy, and barrette). Identification of objects that were not present, false-positives, occurred 1-2 times per radiologist(mean 1.4). An additional 17% of unique objects were identified by less than half of the radiologists. Agreement between radiologists was considered almost perfect(kappa 0.86 ± 0.08, P < 0.0001).CONCLUSION: We demonstrate potential non-identification of commonly ingested non-metal FBs in children. A registry for radiographic visibility of ingested objects should be created to improve clinical decision-making.

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.

Economic Evaluation of Conventional Radiography with Film and Computed Radiography: Applied at BMC

Conventional radiography with film (CRF) has been in use for diagnostic purposes for a long time now. It has proved to be a great assert for the radiographers in assessing various abnormalities. With recent advances in technology it is now possible to have digital solutions for radiography problems at a very cost effective, environment friendly and also with better image quality in certain applications when compared to CRF. Rather than using a CRF a computed radiography (CR) uses imaging plates to capture the image. The imaging plate contains photosensitive phosphors which contain the latent image. Later this plate is introduced into a reader which is then converted into a digital image. The major advantage and the cost effective element of this system is the ability to reuse the imaging plates unlike the photographic film where in only a single image can be captured and cannot be reused. The computed radiography drastically reduces the cost by eliminating the use of chemicals like film developers and fixers and also the need for a storage room. It also helps to reduce the costs that are involved in the disposal of wastes due to conventional radiography. This paper investigates whether it is cost effective to use computed radiography over film based system at Al-Batnan Medical Center (BMC), Tobruk, Libya by using Cost Benefit Analysis (CBA). Apart from the initial cost of the CR System, based on the data collected from the center, from the year 2008 to 2012 (until June 2012) a total of 581,566 images were produced with the total cost incurred using film based system being USD 4,652,528. If the same number of images were produced using a CR system the total cost incurred would have been USD 82,600. Taking into consideration the cost of a new CR system to be USD 120,000 the overall cost of producing these images is USD 202,600. It is observed that an amount of USD 4,449,928 could have been saved over the period of 5 years starting from 2008 to 2012 by using the CR system at BMC. Using Cost Benefit Analysis, the average value of the net difference between the costs and benefits for the conventional film based system is ?83.38 where as for the Computed System it is 22.06. Based on the principles of Cost Benefit Analysis it can be concluded that the system with a net positive difference is more cost beneficial than the other. With the help of the above two analysis it can be concluded that the use of computed radiography is definitely more cost effective for use at BMC, when compared to the conventional x-ray radiography.

X-Ray Image Interpretation Guide for Aviation Aluminum Alloy Castings

The purpose of this paper is to introduce the basic steps of X-ray image interpretation of aviation castings,so as to provide a learning guidance for beginners and reduce the exploration time.Among them,the introduction of specifications,the requirements for image quality,and the application of reference radiographs are just a sorting out the key points.If there is a need for practical application,we should conduct a deeper exploration and understanding of each specification,not just cite this article.

两种锥形束CT转化二维图像与传统头颅侧位片定量分析颈椎骨龄的一致性

背景:传统的头颅侧位片始终存在放大失真、左右重叠不一致等问题,而锥形束CT能真实展现颅面部的三维结构。对锥形束CT进行三维重建,再将所选区域内的锥形束CT转化为二维图像,能使左右侧基本重叠一致且能减小周围组织结构的影响。目的:探究两种不同整合厚度的锥形束CT转化二维图像与传统头颅侧位片定量分析颈椎骨龄的一致性。方法:收集118例青少年正畸患者的锥形束CT及头颅侧位片资料。首先在3D imaging software中对锥形束CT影像进行三维重建,重建后在矢状向界面中分别选择两种不同整合厚度的锥形束CT影像并转化为二维图像,两种图像分别被命名为ICB-1、ICB-2。再运用智贝云对头颅侧位片、ICB-1、ICB-2中的第2颈椎基底部凹陷与椎体下缘所成的角度(@2)、第3颈椎与后面高的比值(AH3/PH3)、第4颈椎高度与宽度的比值(H4/W4)及颈椎骨龄等项目进行测量计算,间隔2周后再随机抽取20例青少年重复上述测量。采用组内相关系数(ICC)法评价3种图像各自测量颈椎骨龄的可重复性;采用配对t检验分析3种图像两两间测量颈椎骨龄的一致性;采用Kappa检验分析3种图像两两组间对颈椎骨龄分期评估的一致性。结果与结论:①除头颅侧位片组AH3/PH3的ICC<0.9,各组其余测量项目ICC均>0.9;②配对t检验结果显示,除ICB-1组与头颅侧位片组、ICB-1组与ICB-2组间AH3/PH3、H4/W4差异有显著性意义(P<0.05),3组其余项目的测量结果两两组间均无统计学差异(P>0.05);③Kappa检验结果显示,3组颈椎骨龄分期评估结果两两组间的Kappa系数均>0.8(P<0.001);④提示ICB-1、ICB-2测量颈椎骨龄的可重复性优于头颅侧位片,头颅侧位片、ICB-1、ICB-2两两组间对颈椎骨龄的测量均有良好的一致性,但考虑到对颈椎椎体结构记录的完整性,ICB-2较ICB-1更适合用于颈椎骨龄定量分析。

FrnkelⅡ型矫治器对儿童上气道矢状径的影响

目的 探讨Fr¨ankelⅡ型功能矫治器对儿童上气道变化的影响。方法 随机抽取经Fr¨ankelⅡ型矫治器治疗的安氏Ⅱ类 1分类错患儿 2 0例 ,其中男、女各 10例 ,年龄 9～ 10岁 ,比较其X线头颅定位侧位片中上气道矢状径在治疗前后的变化。结果 治疗后 ,儿童骨性鼻咽 (PNS_Ba)、Mcnamara线、软腭—软腭后咽壁距 (SPP_SP PW)、舌咽部最小距离 (P_T)和喉咽部会厌谷—下咽壁距 (V_LPW )明显增大 ,与腺样体有关的两项测量指标 (Ad1_PNS ,Ad2_PNS) ,以及悬雍垂_中咽壁距 (U_MPW)、舌咽后气道间隙 (TB_TPPW)治疗前后无显著性差异。

口腔正畸中3种常用头影测量技术的对比研究

目的:比较口腔正畸中常用的3种头影测量技术的差异,为临床运用提供参考。方法:对21例正畸病例进行CBCT扫描和X线头颅侧位摄片,CBCT扫描数据输入SimPlant软件,采用多平面重建定点法描记标志点。头颅侧位片输入WinCeph软件并测量。对比测量颅颌骨及牙齿的角度、线距等测量指标。结果:CBCT-3D和CBCT-2D比较中,PFH、GoLMe-PoLOrL和L1-PoLOrL存在显著性差异(P<0.01)。传统X线头颅侧位片与CBCT-3D、CBCT-2D的比较中,AFH、PFH、AFH/PFH、GoMe-PoOr和FH-OcP均存在显著性差异(P<0.05)。结论:CBCT三维测量技术的可靠性优于传统X线片二维测量技术,但是三维测量结果不完全等同于传统二维测量,三维测量技术期待标准化的统一。

安氏Ⅲ类错正畸前后颞下颌关节形态变化的研究

目的 探讨骨性和功能性Ⅲ类错牙合在正畸前、后颞下颌关节形态变化与颞下颌关节紊乱病 (TMD)之间的关系。方法 利用矫正薛氏位X线片在正畸前后对Ⅲ类骨性错牙合正畸前 19例和正畸后 11例、功能性错牙合正畸前 2 0例和正畸后 18例的双侧颞下颌关节的髁突居关节窝中的位置 (前移、居中、后移 ) ,从上述两类错牙合患者中各选 5例做双侧颞下颌关节矢状位核磁共振扫描 ,观察正畸前、后关节盘的位置及形态变化。结果 正畸前Ⅲ类功能性和骨性错牙合髁突居关节窝前位 ;正畸后Ⅲ类功能性错牙合髁突居关节窝中位 ,Ⅲ类骨性错牙合髁突仍居关节窝前位。正畸前、后功能性Ⅲ类错牙合关节盘位置及形态均基本正常 ;Ⅲ类骨性错牙合正畸后有少部分患者髁突明显前移 ,关节盘形态异常。结论 正畸前后功能性Ⅲ类错牙合颞下颌关节结构基本正常 ,与TMD关系不密切 ;骨性Ⅲ类错牙合正畸后关节结构表现出异常 ,提示与TMD有关 。

颈椎曲率指数(Ishihara法)与颈椎(C_(2-7))夹角的关系

目的 探讨颈椎曲率指数 (Ishihara法 )与颈椎 (C2 - 7)夹角的关系。方法 随机选择 6 3例颈椎病患者的颈椎侧位 X线片 ,测量颈椎曲率指数和颈椎 (C2 - 7)夹角。结果 颈椎曲率指数 (Ishihara法 )平均为 10 .1(SD,11.6 ) ,颈椎(C2 - 7)夹角平均为 17.5 (SD,13.5 ) ,两种方法明显相关 (P<0 .0 1)。结论 颈椎曲率指数 (Ishihara法 )与颈椎 (C2 - 7)夹角呈显著相关。

上颌埋伏尖牙引起切牙牙根吸收的预测

目的:结合锥形束CT(CBCT),通过分析曲面断层片、头颅侧位片,得出上颌埋伏尖牙引起切牙牙根吸收的预测方程。方法:收集符合标准的病例,根据邻近切牙是否发生吸收分成吸收组和未吸收组.所有患者拍摄曲面断层片、头颅侧位片和CBCT并进行测量。结果:确定与切牙牙根是否发生吸收相关的指标,建立切牙牙根吸收预测方程。结论:通过对曲面断层片和头颅侧位片的测量,可初步预测上颌埋伏尖牙是否已造成邻近切牙牙根吸收。中切牙预测方程准确率高,具有一定临床意义;侧切牙预测准确率较低,尚无法应用于临床。

股骨头前外侧骨质状态在股骨头坏死塌陷进展中的作用（英文）

背景:机械应力在股骨头坏死塌陷进展中起重要作用。因此,负重区骨结构的状态可能是塌陷的危险因素。目的:研究股骨头坏死前外侧部分负重区的骨保留与塌陷进展之间的关系。方法:选取未经系统治疗的87例102髋经MRI诊断为ARCOⅡ期的股骨头坏死患者。通过双髋正位和蛙式侧位X射线片观察股骨头塌陷与负重区骨量保留情况。按照坏死病变部位与股骨头前外侧部的关系,将坏死分为3种类型:1型:坏死区位于后内侧和中心部位;2型;坏死区占据前外侧一部分;3型:坏死区涉及整个前外侧部。对不同类型的塌陷发生率和塌陷时间进行评估。结果与结论:(1)所有患者经历3-58个月的随访;(2)在所有塌陷的60髋中,46髋(76.7%)由双髋正位X射线片证实塌陷,57髋(95.0%)由蛙式侧位X射片证实有塌陷,有显著差异(P<0.01);(3)102髋ARCOⅡ期股骨头坏死,3型塌陷率明显高于2型(P <0.001),且发生塌陷的时间明显较短。6髋1型股骨头坏死在随访期均未发生塌陷;(4)结果提示,股骨头坏死前外侧部的骨保留与潜在的塌陷进展有关。

安氏Ⅲ类错关节窝、髁突、关节盘位置及关节盘形态变化的研究

目的为探讨骨性和功能性Ⅲ类错与颞下颌关节紊乱病之间的关系。方法利用矫正薛氏位片对Ⅲ类骨性错19人，功能性错20人的双侧颞下颌关节的髁突居关节窝的位置进行评价，并依据髁突居关节窝中的位置（前移、居中、后移），从上述两类错中各选5人做双侧颞下颌关节矢状位核磁共振扫描，观察关节盘的位置及形态变化。结果每一类型错髁突居关节窝中的位置并不一致，但位置分布比较集中，Ⅲ类骨性和功能性错髁突明星居关节窝前位，当髁突居前位或中位时，关节盘位置在正常范围且形态为正常的双凹形，髁突居后位时，关节盘位置在正常范围或轻度前移，形态也都表现正常。结论Ⅲ类骨性和功能性错颞下颌关节结构基本正常，与颞下颌关节紊乱病关系不密切。

X线片上推测上颌窦的侧面积

目的：利用多元回归方程式探讨X缘颅侧位片上颌窦前后径、高径与侧面积的关系。方法：对18～76岁正常成年人103名（男67人，女36人）的X线颅侧位片进行了上颌窦前后径（X1）、高径（X2）和侧面积（y）的测量。结果：X1、X2与Y之间呈正相关关系，相关系数有显著性差异，建立男女共用的多元回归方程式：y（mm^2）=27．02X2-5.81X1-65.65。经回代检验，可信率为96．13％。结论：成人上颌窦侧面积可用多元回归方程式推算。

利用曲面断层片进行下颌骨测量的研究

目的评价利用曲面断层片进行下颌骨测量的可行性。方法分别测量51例患者的曲面断层片和头颅侧位片上的下颌角、下颌升支长、下颌体长、下颌综合长几项指标,分析其相关性。结果下颌角、下颌升支长、下颌体长度、下颌综合长的测量值在曲面断层片上与头颅侧位片上的相应指标呈显著相关。结论在统一拍摄条件下,曲面断层片能够用做下颌骨的测量。

胸/腹片检测气腹:站立侧位与后前位投影比较

目的 探讨站立侧位胸 /腹片在少量气腹检测的应用价值并与站立后前位胸 /腹片相比较。方法 前瞻性评价了站立侧位和后前位胸 /腹片在连续 10 0例已知各种原因气腹中显示膈下游离气体的能力。用McNemar’stest方法评价了两者间敏感性的差异。结果 站立侧位胸 /腹片对患者气腹的显示率为 98% ;站立后前位胸 /腹片的显示率仅为 80 % ;站立侧位胸 /腹片显示气腹明显优于站立后前位胸 /腹片 (P <0 .0 5 )。结论 在检测少量气腹时 ,站立侧位胸 /腹片较站立后前位胸 /腹片更敏感。