Accuracy Of Radiography Research Articles

Assessing the Bone Age of Children in an Automatic Manner Newborn to 18 Years Range.

Bone age assessment (BAA) is a radiological process to identify the growth disorders in children. Although this is a frequent task for radiologists, it is cumbersome. The objective of this study is to assess the bone age of children from newborn to 18years old in an automatic manner through computer vision methods including histogram of oriented gradients (HOG), local binary pattern (LBP), and scale invariant feature transform (SIFT). Here, 442 left-hand radiographs are applied from the University of Southern California (USC) hand atlas. In this experiment, for the first time, HOG-LBP-dense SIFT features with background subtraction are applied to assess the bone age of the subject group. For this purpose, features are extracted from the carpal and epiphyseal regions of interest (ROIs). The SVM and 5-fold cross-validation are used for classification. The accuracy of female radiographs is 73.88% and of the male is 68.63%. The mean absolute error is 0.5years for both genders' radiographs. The accuracy a within 1-year range is 95.32% for female and 96.51% for male radiographs. The accuracy within a 2-year range is 100% and 99.41% for female and male radiographs, respectively. The Cohen's kappa statistical test reveals that this proposed approach, Cohen's kappa coefficients are 0.71 for female and 0.66 for male radiographs, p value < 0.05, is in substantial agreement with the bone age assessed by experienced radiologists within the USC dataset. This approach is robust and easy to implement, thus, qualified for computer-aided diagnosis (CAD). The reduced processing time and number of ROIs facilitate BAA.

Incorporating Cone-Beam CT Into the Diagnostic Algorithm for Suspected Radiocarpal Fractures: A New Standard of Care?

OBJECTIVE. The purpose of this study was to assess the result of adding cone-beam CT to the standard imaging algorithm for patients with suspected radiographically occult traumatic radiocarpal fractures. SUBJECTS AND METHODS. A prospective review was performed on all patients who had cone-beam CT investigation of acute wrist pain after normal initial radiographs. Patients with no identified fractures were clinically reassessed and referred for MRI if concern for a fracture persisted. RESULTS. In all, 117 patients were assessed; 50.4% had fractures identified with a total of 67 radiographically occult fractures. One fracture was identified on MRI that was not seen on cone-beam CT. Cone-beam CT had sensitivity of 98.3% (95% CI, 91.1-100%), specificity of 100% (95% CI, 93.7-100%), positive predictive value of 100%, and negative predictive value of 98.3% (95% CI, 89.1-100%). Accuracy was 99.1% (95% CI, 95.3-100%). CONCLUSION. Incorporating cone-beam CT into routine clinical practice as part of a standardized diagnostic algorithm yielded a 50% fracture detection rate in patients with negative wrist radiographs but ongoing clinical concern for radiocarpal fracture. Cone-beam CT provides more diagnostic information than radiographs at a lower radiation dose than conventional MDCT. Given the poor accuracy of radiographs for acute radiocarpal fractures and the high fracture prevalence in this cohort, we feel that cone-beam CT should be regarded as the new standard of care in the investigation of these patients.

Accuracy of appendicular radiographic image interpretation by radiographers and junior doctors in Ghana: Can this be improved by training?

IntroductionAccess to image interpretation in Ghana remains a challenge with the limited number of radiologists. Radiographers with the right skills and knowledge in image interpretation could help address this challenge. The aims of the study were to determine and compare the ability (accuracy, sensitivity and specificity) of radiographers and junior doctors in interpreting appendicular trauma radiographs both before and after training. MethodsAn action research study involving a pre and post training test was carried out to determine the level of accuracy, sensitivity and specificity in abnormality detection by radiographers after undergoing training when compared to junior doctors. Eight radiographers and twelve junior doctors were invited to interpret an image bank of 30 skeletal radiographs, both before and upon completion of an educational program. The participants’ tests were scored against a reference standard provided by an experienced radiologist. Pre and post-test analysis were carried out for comparison. ResultsPost training mean accuracy (radiographers 83.3% vs 68.8%, p = 0.017; doctors 81.9% vs 71.6%, p = 0.003), sensitivity (radiographers 83.3% vs 69.2%, p = 0.042; doctors 77.2% vs 67.8% p = 0.025) and specificity (radiographers 83.3% vs 68.3%, p = 0.011; doctors 86.7% vs 75.6% p = 0.005) of both groups significantly improved. No significant differences were recorded between the radiographers and doctors after the training event. ConclusionThe study revealed that, with a well-structured training program, radiographers and junior doctors could improve on their accuracies in radiographic abnormality detection and commenting on trauma radiographs.

A Pediatric Medial Epicondyle Fracture Cadaveric Study Comparing Standard AP Radiographic View With the Distal Humerus Axial View.

Controversy exists with regard to the amount of fracture displacement that warrants surgical fixation of medial epicondyle fractures. Inaccurate determination of degree of displacement on plain radiographs may account for the disputed management. Recently, a novel distal humerus axial radiograph technique has been developed to improve the accuracy of radiographs. The purposes of the study are 2-fold; to identify the anatomic orientation of the medial elbow epicondyle physis in children and to compare the accuracy of determining fracture displacement between axial radiographs and standard anterior-posterior (AP) radiographs in a cadaveric medial epicondyle fracture model. Twelve pediatric elbow computed tomographic scans and 19 pediatric elbow magnetic resonance imaging scans were analyzed for the orientation of the medial elbow physis. After determining the correct orientation, 15 adult cadaveric medial epicondyle fracture models were created at displacements of 2, 5, 10 mm, and maximum displacement with elbow at 90 degrees of flexion. A linear mixed model regression analysis was used to compare displacement based on the axial versus the AP radiographic methods. The medial epicondyle physis was found to be a posterior structure angled distally at ~36 degrees (range, 10.7 to 49.6) and angled posteriorly at 45 degrees (range, 32.2 to 59). The AP radiograph significantly underestimated displacement relative to the axial radiograph at 5 mm [mean difference, -1.6; 95% confidence interval (CI), -2.9 to -0.3], at 10 mm (mean difference, -4.5; 95% CI, -5.8 to -3.2 mm), and at maximal displacement (mean, 15 mm; range, 13 to 20 mm) (mean difference, -7.1; 95% CI, -8.3 to -5.8). The medial epicondyle physis of the distal humerus is a posterior structure angled distally and posteriorly. When displacement was >5 mm, the distal humerus axial radiograph technique was significantly more accurate than the AP radiograph technique at determining actual fracture displacement in our adult cadaveric fracture models. Therefore, we recommend clinicians to include the axial radiograph view during the evaluation of patients with medial epicondyle fractures. This study provides further insight into the location and orientation of the medial humeral epicondyle physis, and further supports the improved accuracy of the distal humerus axial radiograph at detecting displacement in medial epicondyle fractures.

Robot-Assisted Versus Fluoroscopy-Guided Pedicle Screw Placement in Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disease

To compare the clinical accuracy and perioperative outcomes for pedicle screw placement in transforaminal lumbar interbody fusion (TLIF) between the robot-assisted (RA) technique and fluoroscopy-guided (FG) technique. Seventy-seven patients scheduled to undergo RA (n= 43) and FG (n= 44) TLIF surgery were included. Patient demographics, radiographic accuracy, and perioperative outcomes were recorded and compared. The accuracy of pedicle screw placement was according to the Gertzbein and Robbins scale and facet joint violation. Perioperative outcomes mainly included operative time, radiation exposure, and revisions. Of the 176 screws in the RA group, 164 screws were grade A, and 9, 2, and 1 screws were grades B, C, and D, respectively. Of the 204 screws in the FG group, 175 screws were grade A, with 16 screws scored as grade B, 8 screws scored as grade C, 3 screws scored as grade D, and 2 screws scored as grade E. The rate of perfect screw position (grade A) was higher in the RA group than in the FG group (93.2% vs. 85.8%, respectively; P= 0.020). In the FG group, 191 screws (93.6%) were clinically acceptable (groups A and B), whereas more acceptable screw positions were achieved in the RA group (98.3%; P= 0.024). Fewer screws in the RA group violated the proximal facet joint (5 vs. 24 screws, respectively; P= 0.001). The radiation dose was lower in the RA group (25.9 ± 14.2 vs. 70.5 ± 27.3 μSv, respectively; P < 0.001). Two screws in the FG group required a revision, but no revision was required in the RA group. RA pedicle screw placement is an accurate and safe procedure in TLIF for lumbar degenerative disease.

The Diagnostic Accuracy of Radiographs and Magnetic Resonance Imaging in Predicting Deltoid Ligament Ruptures in Ankle Fractures.

Operative indications for supination-external rotation (SER) ankle fractures depend on the integrity of the medial structures. Despite the importance of assessing deep deltoid ligament injuries, the accuracy of common diagnostic tests has not been established. The objective of this study was to compare the ability of injury (non-stress) and stress radiographs and magnetic resonance imaging (MRI) to diagnose deep deltoid ligament ruptures in operative SER ankle fractures. Patients were included who underwent surgical fixation of SER ankle fractures and had appropriate injury and manual stress test radiographs, pre-operative ankle MRI, and intra-operative assessment of deep deltoid integrity by direct visualization. The medial clear space (MCS) was considered positive for all values over 5mm on the injury or stress mortise radiographs. MRI analysis of the deep deltoid ligament injury was performed by blinded fellowship-trained musculoskeletal radiologists. Intra-operative direct visualization and assessment of the deltoid was performed using a direct medial ankle approach at the time of operative fracture fixation. Using intra-operative visualization as the gold standard, MCS measurements and MRI had differing abilities to diagnose a deep deltoid rupture. In cases where the MCS was less than 5mm on injury radiographs and stress tests were performed, MCS measurements were much less accurate than MRI in predicting deltoid ruptures (46% versus 79%, respectively) with a high false positive rate (80%). In contrast, an MCS measurement of greater than 5mm on injury radiographs was a strong predictor of deep deltoid rupture (accuracy of 95%). Compared with direct visualization of the deltoid ligament intra-operatively, these data support proceeding with surgery when the MCS on injury radiographs is greater than 5mm without any additional stress tests or advanced imaging. When the MCS is less than 5mm, we recommend MRI analysis because of its increased accuracy and decreased false positive rate. Improving our ability to diagnose deltoid ruptures will contribute to more effective management of patients with SER ankle fractures.

Tests to detect and inform the diagnosis of caries

Background Root caries is a well-recognised disease, with increasing prevalence as populations age and retain more of their natural teeth into later life. Like coronal caries, root caries can be associated with pain, discomfort, tooth loss, and contribute significantly to poorer oral health-related quality of life in the elderly. Supplementing the visual-tactile examination could prove beneficial in improving the accuracy of early detection and diagnosis. The detection of root caries lesions at an early stage in the disease continuum can inform diagnosis and lead to targeted preventive therapies and lesion arrest. Objectives To assess the diagnostic test accuracy of index tests for the detection and diagnosis of root caries in adults, used alone or in combination with other tests. Search methods Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles. Selection criteria We included diagnostic accuracy study designs that compared one or more index tests (laser fluorescence, radiographs, visual examination, electronic caries monitor (ECM), transillumination), either independently or in combination, with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. In vitro and in vivo studies were eligible for inclusion but studies that artificially created carious lesions were excluded. Data collection and analysis Two review authors extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) specific to the review context. Estimates of diagnostic test accuracy were expressed as sensitivity and specificity with 95% confidence intervals (CI) for each dataset. We planned to use hierarchical models for data synthesis and explore potential sources of heterogeneity through meta-regression. Main results Four cross-sectional diagnostic test accuracy studies providing eight datasets with data from 4997 root surfaces were analysed. Two in vitro studies evaluated secondary root caries lesions on extracted teeth and two in vivo studies evaluated primary root caries lesions within the oral cavity. Four studies evaluated laser fluorescence and reported estimates of sensitivity ranging from 0.50 to 0.81 and specificity ranging from 0.40 to 0.80. Two studies evaluated radiographs and reported estimates of sensitivity ranging from 0.40 to 0.63 and specificity ranging from 0.31 to 0.80. One study evaluated visual examination and reported sensitivity of 0.75 (95% CI 0.48 to 0.93) and specificity of 0.38 (95% CI 0.14 to 0.68). One study evaluated the accuracy of radiograph and visual examination in combination and reported sensitivity of 0.81 (95% CI 0.54 to 0.96) and specificity of 0.54 (95% CI 0.25 to 0.81). Given the small number of studies and important differences in the clinical and methodological characteristics of the studies we were unable to pool the results. Consequently, we were unable to formally evaluate the comparative accuracy of the different tests considered in this review. Using QUADAS-2 we judged all four studies to be at overall high risk of bias, but only two to have applicability concerns (patient selection domain). Reasons included bias in the selection process, use of post hoc (data driven) positivity thresholds, use of an imperfect reference standard, and use of extracted teeth. We downgraded the certainty of the evidence due to study limitations and serious imprecision of the results (downgraded two levels), and judged the certainty of the evidence to be very low. Authors' conclusions Visual-tactile examination is the mainstay of root caries detection and diagnosis; however, due to the paucity of the evidence base and the very low certainty of the evidence we were unable to determine the additional benefit of adjunctive diagnostic tests for the detection and diagnosis of root caries.

Investigating cell blood counter and abdominal radiography accuracy in diagnosis of acute suppurative appendicitis among patients under surgery

Background: Acute appendicitis is the most common surgical emergencies; while unusual symptoms have a differential diagnosis. This study aimed to determine the diagnostic accuracy of CBC and abdominal X-ray in acute suppurative appendicitis.&#x0D; Methods: This cross-sectional study was performed on 198 patients. For all patients, complete blood count and abdominal X-ray were recorded. The pathological report after surgery was the gold standard for diagnosis. Then indicators of the validity of tests CBC, X-ray and neutrophil to lymphocyte ratio, consisted of positive predictive value (PPV) and negative predictive value (NPV), sensitivity, specificity, were analyzed.&#x0D; Results: Out of patients, 133 of patients were male (67.2%), and 65 (32.8%) were female with mean age of 29.13 years. Acute appendicitis confirmed in 77.8% of pathological study, and 17.7% was the normal appendix. Leukocytosis, NLR and abdominal X-ray tests, each have a sensitivity of 89.5%, 78.5% and 100%, specificity of 31.4%, 31.4% and 31.8%, PPV 85.8%, 84.2% and 53.9%, NPV 39.2%, 23.9% and 100%, respectively. There was a significant relationship between appendicitis and WBC&gt; 10.000 and abdominal radiography findings.&#x0D; Conclusion: Due to the sensitivity of performing CBC and leukocytosis and NLR is at an acceptable level, especially with a relatively high positive predictive value, could be concluded that the positivity of these tests for confirming the diagnosis in suspected cases might be helpful and can help to strengthen the clinical diagnosis. Our results in relation to the x-ray of the abdomen suggest its usefulness in the diagnosis of appendicitis.&#x0D;

Radiographic Accuracy in Scaphoid Waist Fractures

All patients with acute scaphoid fractures treated at our hospital in a 4-year period that had a CT scan and plain radiographs were evaluated. The maximum displacement seen on either AP or lateral X-rays was measured as well as the amount of palmar flexion through the fracture as seen on the lateral X-ray. The differences were calculated and the mean of the sum of the differences was calculated.

Accuracy of digital panoramic radiographs on the vertical measurements of dental implants

Objectives: Panoramic radiography (PR) is the most commonly used technique to evaluate the dental and associated structures. The aim of this study was to determine the accuracy of panoramic radiographs (PRDs) in planning of dental implant treatment and the magnification rate of a panoramic device for anterior, premolar and posterior regions.Materials and Methods: Eighty-eight patients, who received PRD after implant surgery, were included to the study. A total of 240 dental implants (53 anterior, 69 premolar, and 118 molar regions) of which previously vertical lengths were known, were re-measured on post-operative radiographic images using the scaling tools of the panoramic system to determine the magnification rate and the accuracy of PRDs. Cause the data had normal distribution, the paired t test was used for the statistical analysis (p&amp;lt;0.05). The magnification rate of the three regions was calculated as the rate of measured vertical length of the implants to the actual vertical length of the implants. Results: Statistically significant difference was found between the actual and measured vertical length of the implants on the PRD (p&amp;lt;0.05). However, the correlation rate was found close to 1 for all regions. The difference between the actual and measured vertical length of the implants on the PRD was 0.50 mm for the anterior region, 0.97 mm for the premolar region, and 0.83 mm for the molar region. The magnification rate of the panoramic system corrected by CliniviewTM (Instrumentarium Corp., Tuusula, FINLAND) software was found around 1 for all the regions. Conclusions: Due to their readily accessible nature and low radiation dose, PRDs can be used in implant surgery for vertical measurements with 1 mm confidence interval.

Customized implants for acetabular Paprosky III defects may be positioned with high accuracy in revision hip arthroplasty

In revision hip arthroplasty, custom-made implants are one option in patients with acetabular Paprosky III defects. In a retrospective analysis, we identified 11 patients undergoing cup revision using a custom-made implant. The accuracy of the intended position of the implant was assessed on post-operative 3D CT and compared to the pre-operative 3D planning in terms of inclination, anteversion, and centre of rotation. In addition, the accuracy of post-operative plain radiographs for measuring implant position was evaluated in relation to the 3D CT standard. We found a mean deviation between the planned and the final position of the custom-made acetabular implant on 3D CT of 3.6° ± 2.8° for inclination and of - 1.2° ± 7.0° for anteversion, respectively. Restoration of center of rotation succeeded with an accuracy of 0.3mm ± 3.9mm in the mediolateral (x) direction, - 1.1mm ± 3.8mm in the anteroposterior (y) direction, and 0.4mm ± 3.2mm in the craniocaudal (z) direction. The accuracy of the post-operative plain radiographs in measuring the position of the custom-made implant in relation to 3D CT was 1.1° ± 1.7° for implant inclination, - 2.6° ± 1.3° for anteversion and 1.3mm ± 3.5mm in the x-direction, and - 0.9mm ± 3.8mm in the z-direction for centre of rotation. Custom-made acetabular implants can be positioned with good accuracy in Paprosky III defects according to the pre-operative planning. Plain radiographs are adequate for assessing implant position in routine follow-up.

Diagnostic Accuracy of Chest Radiograph, and When Concomitantly Studied Lung Ultrasound, in Critically Ill Patients With Respiratory Symptoms: A Systematic Review and Meta-Analysis

Chest radiograph is considered the first-line diagnostic imaging modality for patients presenting with pulmonary symptoms in the ICU. In this meta-analysis, we aim to evaluate the diagnostic accuracy of chest radiograph, and when concomitantly studied lung ultrasound, in comparison with the gold-standard CT for adult critically ill patients with respiratory symptoms. PubMed, EMBASE, and Gray literature. Studies comparing chest radiograph, and if performed lung ultrasound, with CT for adult ICU patients with respiratory symptoms. Quality was scored with Quality Assessment of Diagnostic Accuracy Studies-2, and study setting, test characteristics, and study design were extracted. In the meta-analysis, we included 10 full-text studies, including 543 patients, and found that chest radiograph has an overall sensitivity of 49% (95% CI, 40-58%) and specificity of 92% (86-95%). In seven studies, where also lung ultrasound was studied, lung ultrasound had an overall sensitivity of 95% (92-96%) and specificity of 94% (90-97%). Substantial heterogeneity was found. A planned subgroup analysis for individual pathologies was performed. The results of four abstract-only studies, included in the systematic review, were considered unlikely to significantly influence results of our meta-analysis. Study limitations were that most studies were of low power combined with methodological limitations. This meta-analysis demonstrates that chest radiograph has a low sensitivity and reasonable specificity compared with CT for detecting lung pathology in critically ill patients. The studies also investigating lung ultrasound, showed lung ultrasound to be clearly superior to chest radiograph in terms of sensitivity with similar specificity, thereby opting to be the first-line diagnostic tool in these patients.

Accuracy of MRI and Varus Stress Radiographs in Diagnosing Fibular Collateral Ligament Injuries

Objectives:To evaluate the diagnostic accuracy of magnetic resonance imaging and varus stress radiographs for FCL tears, and compare these modalities to intraoperative findings.Methods:All patients who underwent an isolated FCL or combined ACL/FCL reconstruction by a single surgeon between 2010 and 2017 with preoperative varus stress radiographs and MRI were included in this study. A control group was comprised of patients with an MRI and intact ACL and FCL. Sensitivity and specificity of diagnosing FCL injuries on MRI were determined based on review by a fellowship-trained musculoskeletal radiologist. The sensitivity of diagnosing an FCL injury based on varus stress radiographs was also determined. Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology.Results:A total of 232 patients were included: 98 patients in the FCL tear group and 134 patients in the control group. Varus stress radiographs were determined to be more sensitive in diagnosing FCL injuries compared to MRI, with an overall sensitivity of 70% compared to 66%. Based on chronicity of the injuries, MRI was more accurate for detecting acute FCL injuries than chronic injuries (p=0.002), and varus stress radiographs were more accurate for detecting chronic FCL injuries than acute injuries (p=0.041).Conclusion:To our knowledge, this is the first clinical study to directly compare the diagnostic accuracy of FCL tear detection utilizing MRI and varus stress radiographs in the same patient cohort. While varus stress radiographs appear to have a higher accuracy overall, the results from our study support the use of both varus stress radiographs and MRI in diagnosing FCL injuries, as MRI is more sensitive in diagnosing an acute FCL tear, and varus stress radiographs are more sensitive in diagnosing a chronic FCL tear.

Are Intraoral Radiographs Accurate in Determining the Peri-implant Marginal Bone Level?

The primary objective of this study was to assess the accuracy of periapical radiographs in determining the peri-implant marginal bone level. The accuracy of the linear measurements on radiographs was considered as the absolute difference between the true, intraoperative or surgical marginal bone level measurements (direct bone measurements during surgical procedures) and the radiographic measured distances. The secondary aims were to identify the variables influencing the radiographic evaluation (arch: mandible/maxilla; implant location: anterior/posterior; timing of implant placement: "early delayed" and "prolonged delayed"). The influence of vestibular and palatal/lingual crestal bone levels was also investigated. STROBE guidelines were followed. As soon as the implant was inserted, the marginal bone levels were recorded using a straight periodontal probe (intraoperative or surgical measurements). At the same time, periapical radiographs were taken. To standardize the radiographic images, periapical radiographs were acquired using the long-cone parallel technique and film holding system. All radiographs were analyzed by two examiners blinded to the surgical measurements. Intraclass correlation coefficient (ICC) was employed to assess the intraobserver and interobserver variability. The descriptive statistics, t test, and multivariate statistics were used; the threshold for statistical significance was P ≤ .05. Two hundred sixty-eight implants were inserted in 142 patients. The interobserver agreement was 0.980; the intraobserver variability was 0.990 and 0.993. The mean difference between the radiographic and surgical measurements was 0.45 mm (range: 0 to 8 mm; SD: 1.76). Comparing the radiographic and surgical measurements, a statistically significant difference (P = .000) was detected. None of the variables considered (arch, implant location, and timing of implant placement) significantly influenced the accuracy. Neither the vestibular alveolar edge (P = .908) nor the lingual/palatal (P = .485) significantly influenced the accuracy. The periapical radiograph statistically significantly overestimates the level of peri-implant marginal bone compared with surgical measurements. The arch, implant location, timing of implant placement, and level of vestibular or lingual/palatal alveolar edge do not influence deviation between the intraoperative peri-implant marginal bone level measurements and the radiographically determined marginal bone levels.

Increased Accuracy of Varus Stress Radiographs Versus Magnetic Resonance Imaging in Diagnosing Fibular Collateral Ligament Grade III Tears

To evaluate the diagnostic accuracy of magnetic resonance imaging and varus stress radiographs for fibular collateral ligament (FCL) tears, and compare these modalities to intraoperative findings. All patients who underwent an isolated FCL or combined anterior cruciate ligament (ACL)/FCL reconstruction by a single surgeon between 2010 and 2017 with preoperative varus stress radiographs and magnetic resonance imaging (MRI) were included in this study. A control group was composed of patients with an MRI and intact ACL and FCL. Sensitivity and specificity of diagnosing FCL injuries on MRI were determined based on review by a fellowship-trained musculoskeletal radiologist, blinded to the pathology associated with each patient (FCL injury vs control), and compared with the gold standard of examination under anesthesia, followed by surgical confirmation of an FCL tear at the time of FCL reconstruction. The sensitivity of diagnosing an FCL injury based on varus stress radiographs was also determined. Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. A total of 232 patients were included: 98 patients in the FCL tear group (mean age: 33.6 ± 12.2years) and 134 patients in the control group (mean age: 44.0 ± 17.2years). Varus stress radiographs were determined to be more sensitive in diagnosing FCL injuries compared with MRI, with an overall sensitivity of 70% compared with 66%, respectively. Based on MRI, overall specificity was 68%. Based on chronicity of the injuries, MRI was more accurate for detecting acute FCL injuries than chronic injuries (P= .002), and varus stress radiographs were more accurate for detecting chronic FCL injuries than acute injuries (P= .041). The results support the use of both varus stress radiographs and MRI in diagnosing FCL injuries, because MRI is more sensitive in diagnosing an acute FCL tear, and varus stress radiographs are more sensitive in diagnosing a chronic FCL tear. Both imaging modalities are recommended to diagnose both acute and chronic FCL injuries. Level II, case-control study.

The Effect of Original and Invert Enhanced Panoramic Modality on the Assessment of the Relationship Between the Maxillary Posterior Roots and the Maxillary Sinus Floor

Background: Having knowledge about the anatomical and pathological relationship between the maxillary posterior root tip and the maxillary sinus floor is very significant for preoperative treatment planning. Aims and Objectives: The purpose of the present study was to compare the accuracy of original panoramic radiographs and digital panoramic images over cone beam computed tomography (CBCT) images in evaluating the relationship between the maxillary posterior teeth and the maxillary sinus floor, and to verify the accuracy of the signs of the relationship between the roots of the maxillary posterior teeth and maxillary sinus on the panoramic radiographs over CBCT images. Materials and Methods: From 106 subjects (47 males and 59 females; mean age = 39 years; range = 18-67 years) referred to our university, a pair of panoramic and CBCT images was selected for further analysis. The relationship between the maxillary posterior teeth, the maxillary sinus, and panoramic radiography signs (root projection into the sinus, interruption of the maxillary sinus floor cortex, absence of lamina dura, darkening of the root apex, and curvature of the sinus floor on the root apex) associated with the protrusion of root apexes into the sinus was evaluated. Results: The P values of the data obtained from the original and invert enhanced panoramic images were .53 and .52, respectively, and there was no statistically significant difference in the accuracy of the 2 methods ( P &gt; .05). Conclusion: The root projection into the sinus is an indicative sign of root protrusion into the sinus on CBCT.

Combining independent decisions increases diagnostic accuracy of reading lumbosacral radiographs and magnetic resonance imaging

Diagnosing the causes of low back pain is a challenging task, prone to errors. A novel approach to increase diagnostic accuracy in medical decision making is collective intelligence, which refers to the ability of groups to outperform individual decision makers in solving problems. We investigated whether combining the independent ratings of chiropractors, chiropractic radiologists and medical radiologists can improve diagnostic accuracy when interpreting diagnostic images of the lumbosacral spine. Evaluations were obtained from two previously published studies: study 1 consisted of 13 raters independently rating 300 lumbosacral radiographs; study 2 consisted of 14 raters independently rating 100 lumbosacral magnetic resonance images. In both studies, raters evaluated the presence of “abnormalities”, which are indicators of a serious health risk and warrant immediate further examination. We combined independent decisions of raters using a majority rule which takes as final diagnosis the decision of the majority of the group. We compared the performance of the majority rule to the performance of single raters. Our results show that with increasing group size (i.e., increasing the number of independent decisions) both sensitivity and specificity increased in both data-sets, with groups consistently outperforming single raters. These results were found for radiographs and MR image reading alike. Our findings suggest that combining independent ratings can improve the accuracy of lumbosacral diagnostic image reading.

In vitro effect of changing the horizontal angulation of X-ray beam on the detection of proximal enamel caries in bitewing radiographs.

Bitewing radiography is an important modality useful for the evaluation of teeth in patients of various ages and in different stages of tooth eruption. Clinical examination of proximal surfaces for caries may result in false negative results, especially in tight contact areas. Thus, radiography, as an adjunct to clinical examination, is used as a routine diagnostic modality for caries detection. The objective of this study was to assess the in vitro effect of changing the horizontal angulation of X-ray beam on the detection of proximal enamel caries in bitewing radiographs. This in vitro study was conducted on 150 caries-free human premolars (code: p/16/35/9/210). The teeth were randomly divided into 3 groups (n = 50). Group 1 served as the control group and no carious lesions were induced in this group. Teeth in groups 2 and 3 were immersed in demineralizing solution for 2 and 4 months, respectively. After induction of caries and its radiographic confirmation, the teeth were mounted in wax in groups of 3 and bitewing radiographs were obtained at 0°, 5°, 10° and 15° horizontal angles. The sensitivity values of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles were 88%, 90%, 88%, 92% in group 2 and 88%, 94%, 94% and 94% in group 3, respectively. The specificity values of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles were 92%, 86%, 84% and 76%. The accuracy of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles was 89.3%, 90%, 88.7% and 87.3%, respectively. The highest diagnostic accuracy was obtained at 5° horizontal angle for caries detection; however, the difference in this regard among the tested horizontal angles was not statically significant (p = 0.846). Based on the results of this study, changing the horizontal angulation has no significant effect on the detection of proximal enamel caries in bitewing radiographs.

Accuracy of digital and film panoramic radiograph for assessment the sites of periapical bone lesions (comparative study )

The dental pulp is a delicate connective tissue , it react to bacterial infection or toother stimuli by an inflammatory response .Once infection has been established in thepulp , spread of the process can be through the root canals and into the periapicallesions.The aim of this study was to evaluate the accuracy of digital and film panoramicradiographs in detection the periapical bone lesion in different sites ,which detectedpreviously by periapical radiographs .In this study 106 teeth were examined by intraoral periapical radiographs which indicated that only 60 teeth were with periapicalbone lesion , then by both digital and film panoramic the teeth with periapical lesionwere examined .The results show significant advantage of digital panoramic whichshow the same mean of periapical lesion like conventional periapical radiographs ,also the study show significant differences between digital and film panoramicradiographs in incisor region for the detection of periapical bone lesion .

Accuracy of radiographic determination of the posterior femoral wall integrity in anterior cruciate ligament reconstruction

ObjectiveTo evaluate the accuracy of radiographs in determining integrity of the posterior femoral cortex following ACL reconstruction. MethodsFifty adult volunteers undergoing primary arthroscopic transtibial ACL reconstructions were prospectively enrolled into this study. Plain radiographs and fine-cut CT of the operative knee were obtained post-operatively. Three blinded orthopaedic surgeons were asked to measure the distance from the femoral tunnel to the posterior cortex on lateral radiographs. Inter/intra-observer reliabilities were assessed with the interclass correlation coefficient. The true measurement of the posterior wall was determined on CT. For each, a measurement was made at the aperture, 5 mm, and 10 mm along the tunnel. Plain radiographic measurements were compared to the CT measurement of back wall using a paired t-test. ResultsAll measurements made on the lateral radiograph were significantly different from those from the respective CT scans for each surgeon (p < 0.0001) at all points. When radiographic measurements were compared to CT at the level of the intra-articular aperture, 29 subjects showed violation of the posterior cortex, with only one being identified on plain films. At 5 mm, 7 subjects demonstrated posterior cortical violation, and none were identified on lateral radiographs. The posterior cortex remained intact in all cases at 10 mm. ConclusionLateral radiographs of the knee are insufficient for evaluation of the posterior cortical integrity following primary ACL reconstruction. Direct visualization of the femoral tunnel remains the gold standard for evaluation of the posterior wall and may be supplemented by CT scan if there remains concern over graft fixation.