Anterior-posterior Projection Research Articles

RADIOGRAPHY TECHNIQUE OF OSSA PELVIS WITH SUSPECTED FRACTURE OF RAMUS PUBIS AT EFARINA ETAHAM HOSPITAL, BERASTAGI KARO DISTRICT 2021

Fracture is a broken bone, a break in bone tissue that is commonly caused by forced injuries. The cause of fracture is an accident, be it a work accident, traffic accident. Broadly speaking, fractures are divided into three types, namely closed fractures, closed fractures, and complex fractures.
 The examination aims to determine the results of radiographic images, if there is a fracture or dislocation and is caused by KLL factors (traffic accidents). The aim of the study was to find out how the radiographic examination technique of Ossa Pelvis with the suspicion of a Ramus Pubis Fracture at the Radiology Installation of Efarina Berastagi Hospital in 2021. This type of research is descriptive research with data collection techniques by observation, documentation study and literature (library) study. The results of the examination of the Ossa Pelvis with the suspicion of a Ramus Pubis Fracture at the Radiology Installation of Efarina Etaham Berastagi Hospital are generally using AP (Anterior Posterior) projections using conventional X-rays. The x-ray film used is a high speed type combined with a fast screen intensifying (IS) where this type of intensifying screen (IS) film can produce images with good detail and sharpness. Thus the radiation dose can also be reduced for the patient and the operator himself. The film washing process should use Automatic Processing. It is hoped that it can be used as a reference for radiographic results, especially in cases of Ramus Pubis Fractures.

Could posterior-anterior projection cervical spine radiographs improve image quality and dose reduction

Introduction: Anterior-posterior (AP) cervical spine X-rays are routine examinations to assess degenerative change, persistent pain and traumatic injuries. Multiple radiosensitive organs lie anteriorly within this anatomical region, increasing the stochastic risk of cancer. If a posterior-anterior (PA) projection was utilised, the radiation dose could potentially be reduced. The hypothesis of this study is to evaluate the change in radiation dose and image quality between AP and PA positions. Materials and methods: An anthropomorphic phantom was positioned AP erect against a digital radiography (DR) detector with 30 thermoluminescent dosimeters (TLDs) inserted to record the thyroid, breast, ovaries, and testes absorbed radiation dose at an exposure of 66 kV and 8 mAs. The phantom was repositioned PA erect and repeated. Images were assessed against an image quality criteria Likert scale by qualified radiographers. The mean and standard deviations were calculated for dose and image quality and compared using a t-test and Wilcoxon Signed Ranks Test. Results: The PA erect cervical spine reduced radiation dose to the right thyroid by 92% (44.7 µGy; p=0.00) and the left thyroid by 89% (43.7 µGy; p=0.00), with further reductions in scatter dose to the breasts (0.35-0.45 µGy; p=0.85), ovaries (0.41 µGy; p=0.57), and testes (0.04 µGy; p=0.98). Image quality scores for the end plates, pedicles, joint spaces, spinous and transverse processes, cortical and trabecular bone patterns, and soft tissues were near equivalent (p=0.32). Conclusion: Data analysis suggests that PA cervical spine positioning for X-rays in the laboratory adheres to as low as reasonably practicable (ALARP) guidance on X-ray examinations to reduce radiation dose to male and female internal organs (thyroid, breast, ovaries) without a reduction in image quality compared to AP positioning. Further research in clinical practice is advised.

Vascular calcification of the abdominal aorta has minimal impact on lumbar spine bone density in patients with chronic kidney disease

Dual-energy X-ray absorptiometry (DXA) measurements are sensitive to artifacts from surrounding tissues. This study investigates the impact of abdominal aortic calcification (AAC) on bone mineral density (BMD) in patients with chronic kidney disease (CKD). In 88 patients with CKD stage G5D, lumbar spine BMD was measured in both anterior-posterior (AP) and lateral DXA projections. AAC was determined from lateral lumbar radiographs. Median age was 51 ± 14 years, and 61 % were men. AAC was present in 59 %. There was no difference in lumbar spine BMD between patients with and without AAC (AP: 0.823 vs. 0.806 g/cm 2 , p = 0.66). The ΔBMD between AP and lateral projections was similar in patients with and without AAC (13.4 ± 6.7 % vs. 11.5 ± 6.3 %; difference 1.9 %, 95 % CI −0.9 to 4.7 %, p = 0.18). When comparing single vertebrae at levels with high vs. low degree of AAC within the same individual, there was no difference in BMD (AP: 0.827 ± 0.202 vs. 0.818 ± 0.291 g/cm 2 , p = 0.78), nor in the ΔBMD between AP and lateral projections (12.9 ± 8.1 % vs. 14.3 ± 8.3 %, p = 0.12). We could not detect an impact of AAC on lumbar spine BMD. These findings challenge the dogma that lumbar spine BMD by DXA is unreliable due to widespread AAC in patients with CKD. • Low BMD is a risk factor for fractures in chronic kidney disease. • Lumbar spine BMD bias by aortic calcification is often cited as a concern. • Anterior-posterior and lateral lumbar spine BMD were compared in this study. • No impact of aortic calcification on lumbar spine BMD was detected. • Any effect of aortic calcification on BMD is likely of limited clinical relevance.

Factors Affecting Image Resolution in a Modern Angiographic Suite: A Phantom-Based Study

BackgroundImprovements in angiographic imaging systems technology provide options to decrease radiation exposure. The effect of these variations on image resolution is unknown. MethodsUsing an American National Standards Institution phantom, a high-contrast (line-pair) and low contrast (Gammex 151) phantoms, 5 second images were acquired using a Phillips Allure angiographic suite, using fluoroscopic capture (FC) as well as cineangiography (CA) in posterior anterior (PA) and left anterior oblique (LAO) projections as well as high and low table positions. Image resolutions were measured as ranked by three independent trained observers blinded to the purpose of the assessments. Comparative analyses were performed. Interobserver agreement was evaluated. ResultsHigh contrast image resolution was significantly lower with FC compared to CA (median [interquartile range], 1.69 [1.52–1.69] mm, vs 2.09 [1.88–2.09] mm, P < 0.001). No significant differences were observed in between PA and LAO projections as well as low and high table positions. Low contrast resolution was also lower with FC compared to CA (5 [6.5–5] vs 3 [5–3] mm, P < 0.001). No significant differences in high-contrast or low-contrast resolution were noted between PA and LAO projections, or high and low table positions. Both low and high-contrast image resolution improved with higher radiation exposure. Good interobserver agreement was noted (Fleiss-Kappa ranging from 0.69–0.74). ConclusionImage resolution was perceived to be better with CA compared to FC, although not significantly affected by beam angulation or table height. Aligning resolution needs with imaging modality and maximizing table height may improve procedural efficacy and safety.

Averted Catastrophic Transseptal Puncture: Percutaneous Transseptal Mitral Commissurotomy in a Patient With Undiagnosed Azygous Continuation of the Inferior Vena Cava

A case is presented of a patient requiring percutaneous mitral balloon commissurotomy. During positioning of the transseptal needle, an unusual needle position on the lateral projection prompted the physician to abandon the puncture and do an angiogram of the inferior vena cava. This revealed an azygous vein continuation. The valve was treated at a later date under general anesthesia with transesophageal echo guidance. This case illustrates how reliance on the posterior-anterior projection to find the optimal point for transseptal puncture can be very misleading and how crucial the lateral projection is.

Using the radiocoronoid line for diagnosis of elbow dislocation.

The radiocapitellar line (RCL) has been widely used to diagnose elbow dislocation. However, there are limitations to the RCL, with the cartilaginous portion of bone making interpretation of radiographs difficult. The study aims to show that the radiocoronoid line, which connects two points on the medial aspect of the radius, proximal to the radial tuberosity, is more suited to diagnose elbow dislocations in the anterior-posterior projection. This study also observes factors affecting accuracy of the radiocapitellar line. The radiographs of 50 normal and 17 laterally dislocated elbows were obtained. An unbiased independent reviewer drew the radiocoronoid and radiocapitellar line (RCL). Four other blinded independent reviewers drew the RCL and the radiocoronoid line for 20 radiographs and repeated the process a week later. The accuracy of the RCL was assessed using distance away from bisection point of capitellum, and ratio (distance from the point where line crosses capitellum to lateral aspect of capitellum over the total width of capitellum). The relationship of the radio-coronoid line and the lateral aspect of coronoid fossa was assessed, with dislocation being the line lateral to it and normal being medial to or on it. The radiocoronoid line had a higher accuracy (95.5%) compared to RCL (32.8%), higher specificity (94%) compared to RCL (10%) as well as higher positive predictive value (85%) compared to RCL (27.4%). There was no intra- or inter-observer variability for the radio-coronoid line. Skeletal age statistically predicted the ratio for the male population ( P < 0.05), however, the independent variables did not statistically predict the dependent variables for the female and total population. The radiocoronoid line serves as an additional method to assess radiocapitellar joint lateral dislocation. It is more accurate and reliable than the radiocapitellar line in the anterior-posterior projection. Sex and skeletal age also influence the accuracy of the radiocapitellar line with the radiocapitellar line nearing the bisection point as skeletal age in males increases.

Impacts of Phantom Off-Center Positioning on CT Numbers and Dose Index CTDIv: An Evaluation of Two CT Scanners from GE.

The purpose of this work is to evaluate the impacts of body off-center positioning on CT numbers and dose index CTDIv of two scanners from GE. HD750 and APEX scanners were used to acquire a PBU60 phantom of Kagaku and a 062M phantom of CIRS respectively. CT images were acquired at various off-center positions under automatic tube current modulation using various peak voltages. CTDIv were recorded for each of the acquisitions. An abdomen section of the PBU60 phantom was used for CT number analysis and tissue inserts of the 062M phantom were filled with water balloons to mimic the human abdomen. CT numbers of central regions of interests were averaged using the Fiji software. As phantoms were lifted above the iso-center, both CTDIv and CT numbers were increased for the HD750 scanner whilst they were approximately constant for the APEX scanner. The measured sizes of anterior-posterior projection images were also increased for both scanners whilst the sizes of lateral projection images were increased for the HD750 scanner but decreased for the APEX scanner. Off-center correction algorithms were implemented in the APEX scanner. Matching the X-ray projection center with the system’s iso-center could improve the accuracy of CT imaging.

Multimodality imaging and clinical significance of isolated congenital absence of the pericardium

Background. Congenital absence of the pericardium is a rare anomaly characterized by variable and non-specific clinical manifestations. The prevalence of this pathology in the population is approximately 0.0001 – 0.044% and it is almost three times more common in men. However, the real prevalence, including asymptomatic and undiagnosed cases, may be higher. Purpose – highlighting the echocardiographic and tomographic signs of isolated congenital absence of the pericardium. Materials and methods. A 42-year-old patient M. Echocardiography did not permit to obtain standard echo images via typical echocardiographic approaches due to poor acoustic window. Magnetic resonance imaging and computed tomography of the heart revealed marked left heart rotation and confirmed the most common variant of congenital absence of the pericardium, that is complete left-sided absence pericardial agenesis. Results. The presented case illustrates the non-specificity of clinical symptoms in patients with congenital absence of the pericardium. The electrocardiogram of the patient showed right axis deviation, right bundle branch block, poor R wave progression in the precordial leads. Chest X-ray in the anterior-posterior projection typically shows a pronounced displacement of cardiac silhouette to the left without deviation of the trachea, elongated left border of the heart and inability to delineate the right border, indicating left heart rotation. Echocardiography revealed an unusual orientation of the heart in the chest, i.e. the displacement of the heart (particularly, of the apical segments) to the left and backwards. In cases when the pericardium is absent on the right and on both sides, the right ventricle can indeed be enlarged, sometimes there is a paradoxical motion of the interventricular septum, severe tricuspid regurgitation as well as the swinging motion of the cardiac apex. Magnetic resonance imaging and computed tomography of the heart enable detection of the displacement of the heart to the left half of the chest with cardiac apex directed backwards, the interposition of lung tissue between the ascending aorta and the pulmonary artery trunk. Conclusions. Congenital absence of the pericardium is a rare pathology and thus it can be challenging in terms of diagnosis, while sometimes it remains undiagnosed. The combination of echocardiography with magnetic resonance imaging and/or computed tomography allows to accurately diagnose congenital absence of the pericardium and assess the risks associated with it. Most patients with complete unilateral or bilateral congenital absence of the pericardium have a favorable prognosis and do not require treatment.

Comparison of standard radiography and magnetic resonance imaging in hand osteoarthritis

Standard radiography in direct projection is the “gold standard” in the diagnosis of hand osteoarthritis (HOA). However, the currently clinically most severe “erosive” or “inflammatory” phenotype of HOA is characterized by the presence of inflammatory symptoms such as bone marrow lession (BML), synovitis and tenosinovitis, which are not visible on the radiograph by the nature of the study due to the low optical density. In addition, X-ray examination is planar and has no possibility of multiplanar visualization. This dictated the need to search for a more informative visualization technique in HOA.Aim – to compare the sensitivity and specificity of standard radiography and magnetic resonance imaging (MRI) techniques in determining the symptoms of osteoarthritis (OA) of the distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the right hand; to determine the indications for the appointment of MRI in patients with HOA.Materials and methods. The study included 64 women with clinically verified diagnosis of HOA according to ask criteria. For the first time, X-rays of the joints of the right hand in the anterior-posterior projection and MRI were performed for each of them. Each patient completed the AUSCAN questionnaire. X-rays were described according to the Kellgren and Lawrence systems, magnetic resonance imaging was analyzed according to the modified OHOA system. The sensitivity and specificity of the methods were compared based on the detection of 4 symptoms detected by radiography and MRI: joint space narrowing (JSN), osteophytes (OP), erosions and subluxations. The average age of the patients was 65.28±6.82 years, the age of onset was 48.81±7.73 years, the duration of the disease was 15.0 (10.0–19.5) years.Results. Both methods showed approximately equal identification JSN symptom in DIP and PIP, 95% definition JSN in MCP. OP were detected in 88% of patients in DIP according to radiography and in 95% – using MRI (p&gt;0.05). In PIP OP were observed in 70% of patients on radiographs and in 86% on magnetic resonance imaging, in MCP – in 45% and 66% of cases, respectively. Erosion in DIP were found in 41% of patients according to MRI and 34% as a result of X-ray examination, in PIP – in 27% and 13% of cases, in MCP – in 60% and 8% of cases, respectively. Subluxations were determined in DIP 23% on radiographs in 31% of cases by MRI, in PIP – in 8% and 6% (p&gt;0.05), in MCP subluxations almost never met – in 3% of cases by conventional radiography.Conclusions. MRI in HOA can be used in the detection of erosive process, differential diagnosis with other diseases of the joints, determination of inflammatory changes in the hands and assessment of their severity, but has no significant advantages over standard radiography in determining the symptoms of degenerative-dystrophic nature (JSN and OP). Subluxations of the MCP joints are not typical for the HOA.

The return to professional activity patients treated surgically due to advanced gonarthrosis.

The goal of this work is to analyze the issue of return to professional activity by working-age patients who have been treated surgically with total knee arthroplasty (TKA) due to gonarthrosis. Overall, 88 working-age patients were examined, with a total of 91 TKA procedures performed due to advanced gonarthrosis. The average age of the patients was 54.2 years for women and 58.1 years for men. A modified Knee Society Score scale was used to compile the results of the clinical trial. The Kellgren-Lawrence classification was used to assess preoperative radiographs. Postoperative radiographs evaluated the position of the endoprosthesis of both the femoral and tibial components in the anteriorposterior and lateral upright projections. The obtained results were subjected to statistical analysis. In the preoperative assessment, both the clinical and radiological results obtained were unfavorable in all cases. Throughout the observation period of approximately over 3.8 years, a very good result was noted in 65 cases (71.4%), a good result in 20 cases (22%), and a satisfactory result in 6 cases. There were no bad results. The average improvement on the Visual Analogue Scale was 6.5 pts. The radiological assessment did not reveal any radiological symptoms of the aseptic loosening of the endoprosthesis, simultaneously concluding that each time the endoprosthesis components were properly seated. Only 53 (58.3%) of the examined patients were professionally active before the surgery. After completing the treatment, 46 (50.5%) of all patients returned to work, in favor of intellectual workers. The average duration of sick leave was 136.2 days, and rehabilitation allowance was granted in 19 cases. Firstly, in working-age patients, TKA is a valuable method for surgical treatment of advanced gonarthrosis of varying etiology. Secondly, most of the patients who worked before the surgery returned to performing work in the position held and on the same full-time equivalent basis. Int J Occup Med Environ Health. 2021;34(5):617-28.

Influence of the use of various imaging units and projections on the radiation dose received by children during chest digital radiography.

ObjectiveTo investigate the impact of the use of different imaging units and projections on radiation dose and image quality during chest digital radiography (DR) in 3- and 4-year-old children.MethodsTwo hundred forty 3- and 4-year-old participants requiring chest DR were included; they were divided into three groups: supine anterior-posterior projection (APP), standing APP and standing posterior-anterior projection (PAP). Each group included 40 participants who were evaluated using the same imaging unit. The dose area product (DAP) and the entrance surface dose (ESD) were recorded after each exposure. The visual grading analysis score (VGAS) was used to evaluate image quality, and the longitudinal distance (LD) from the apex of the right lung to the apex of the right diaphragm was used to evaluate the inspiration extent.ResultsDAP and ESD were significantly lower in the standing PAP and APP groups than in the supine APP group (P<0.05), but LD was significantly higher in the standing PAP and APP groups than in the supine APP group (P<0.05). Additionally, the pulmonary field area was significantly higher for the standing PAP group than for the standing and supine APP groups (P<0.05). The correlations between ESD, DAP, and VGAS were positive (P<0.001), showing that larger ESD and DAP correspond to higher VGAS. The correlations between ESD, DAP, and body mass index (BMI) were also positive (P<0.05), indicating that higher BMI corresponds to larger ESD and DAP. Finally, no differences in DAP, ESD, VGAS, LD, pulmonary field area, or BMI were noted between males and females (P>0.05).ConclusionThe radiation dose to superficial organs may be lower with standing PAP than with standing APP during chest DR. Standing PAP should be selected for chest DR in 3- and 4-year-old children, as it may decrease the required radiation dose.

Anterior knee pain causes after total knee arthroplasty

The objective of the study was to determine the causes of postoperative anterior knee pain after total knee arthroplasty for preventing its occurrence and improving the surgery results.The treatment results of 77 (112 cases) patients with cruciate-retaining total knee arthroplasty without patellar replacement were analyzed. The study involved 62 (80.5 %) women and 15 (19.5 %) men. The average age (Me (25‒75 %)) of the patients was 65 (60‒70) years. There were 97 cases (87 %) with varus deformity of the knee joint, 15 cases with valgus deformity (13 %). The average angle of varus deformity was 11.22 ± 3.81°, the average angle of valgus deformity was 11 ± 4.27°. After the anterior pain appeared, patients were examined in 2‒3, 4‒5 and 6‒7 months after surgery using clinical, X-ray (anterior-posterior, lateral and axial projections, topogram of lower extremities), and EMG methods.The causes of anterior postoperative knee pain were: implant components misplacement, patellar microcirculation disorders (chondrolysis, avascular necrosis due to circular patella denervation), patellofemoral joint imbalance, and functional causes. Pain manifested itself at active leg loading and knee motion because of implant components misplacement within 2‒3 months in 34 cases (94 %), 4‒5 months ‒ in 2 cases (6 %). Patellar microcirculation disorders within 4‒5 months ‒ in 5 cases (21 %), 6‒7 months ‒ in 19 (79 %) cases. Imbalance in the patellofemoral joint within 2‒3 months ‒ in 29 cases (69 %), 4‒5 months ‒ in 13 cases (31 %). Functional causes of pain appeared within 2‒3 months ‒ in 7 cases (70 %), 4‒5 months ‒ in 3 cases (30 %).The causes of postoperative anterior pain in total knee arthroplasty can be incorrect surgical technique, changes in patellar blood supply or in the biomechanics of the patellofemoral joint due to the imbalance of the thigh muscles.

A Novel Catheterization Laboratory Radiation Shielding System: Results of Pre-Clinical Testing

BackgroundThis pre-clinical study evaluated the efficacy of a novel shielding system to reduce scatter radiation in the cardiac catheterization laboratory. MethodsUsing a scatter radiation phantom in a standard cardiac catheterization laboratory, a radiation physicist recorded radiation measurements at 20 reference points on the operator side of the table. Measurements were made with fluoroscopy and cine with the C-arm in the posterior-anterior (PA) and 40 degrees left anterior oblique (LAO) orientations. Scatter radiation doses were compared with and without use of the shielding system. ResultsUse of the shielding system was associated with >94.2% reduction in scatter radiation across all reference points in the PA and LAO projections with fluoroscopy and cine. With the shielding system, dose reductions at the location of the primary operator ranged from 97.8% to 99.8%. At locations of maximum scatter radiation, use of the shielding system resulted in dose reductions ranging from 97.8% to 99.8% with fluoroscopy and from 97.9% to 99.8% with cine. ConclusionsIn this pre-clinical study, a novel radiation shielding system was observed to dramatically reduce scatter radiation doses. Based on these results, clinical testing is warranted to determine whether the shielding system will enable operators and staff to perform interventional procedures with less radiation exposure that may obviate the need to wear standard lead apparel. Indexing wordsRadiation safety; occupational health; occupational hazard.

Radiation Effective Doses to Adults Undergoing Modified Barium Swallow Studies.

Modified Barium Swallow Studies (MBSSs) are important tests to aid the diagnosis of swallowing impairment and guide treatment planning. Since MBSSs use ionizing radiation, it is important to understand the radiation exposure associated with the exam. This study reports the average radiation dose in routine clinical MBSSs, to aid the evidence-based decision-making of clinical providers and patients. We examined the MBSSs of 200 consecutive adult patients undergoing clinically indicated exams and used kilovoltage (kV) and Kerma Area Product to calculate the effective dose. While 100% of patients underwent the exam in the lateral projection, 72% were imaged in the upper posterior-anterior (PA) projection and approximately 25% were imaged in the middle and lower PA projection. Average kVs were 63kV, 77kV, 78.3kV, and 94.3kV, for the lateral, upper, middle, and lower PA projections, respectively. The average effective dose per exam was 0.32 ± 0.23mSv. These results categorize a typical adult MBSS as a low dose examination. This value serves as a general estimate for adults undergoing MBSSs and can be used to compare other sources of radiation (environmental and medical) to help clinicians and patients assess the risks of conducting an MBSS. The distinction of MBSS as a low dose exam will assuage most clinician's fears, allowing them to utilize this tool to gather clinically significant information about swallow function. However, as an X-ray exam that uses ionizing radiation, the principles of ALARA and radiation safety must still be applied.

Patterns of seizure spread in temporal lobe epilepsy are associated with distinct white matter tracts

ObjectiveIt is commonly hypothesized that seizure spread patterns in patients with focal epilepsy are associated with structural brain pathways. However, this relationship is poorly understood and has not been fully demonstrated in patients with temporal lobe epilepsy. Here, we sought to determine whether directionality of seizure spread (DSS) is associated with specific cerebral white matter tracts in patients with temporal lobe epilepsy. MethodsThirty-three adult patients with temporal lobe epilepsy who underwent stereoelectroencephalography (sEEG) and magnetic resonance diffusion tensor imaging (MR-DTI) as part of their standard-of-care clinical evaluation were included in the study. DSS was defined as anterior-posterior (AP) or medial-lateral (ML) spread based upon sEEG evaluation by two independent specialists who demonstrated excellent inter-rater agreement (Cohen’s kappa = .92). DTI connectometry was used to assess differences between seizure spread pattern groups along major fiber pathways regarding fractional anisotropy (FA). ResultsTwenty-four participants showed seizures with AP spread and nine participants showed seizures with ML spread. There were no significant differences between the groups on their demographic and clinical profile. Patients with ML seizures had higher FA along the corpus callosum and, to a lesser degree, some portions of the bilateral cingulate tracts. In contrast, patients with AP seizures had higher FA along several anterior-posterior white matter projections bundles, including the cingulate fasciculus and the inferior longitudinal, with significantly less involvement of the corpus callosum compared with ML seizures. SignificanceThis study confirms the hypothesis that the anatomical pattern of electrophysiological ictal propagation is associated with the structural reinforcement of supporting pathways in temporal lobe epilepsy. This observation can help elucidate mechanisms of ictal propagation and may guide future translational approaches to curtail seizure spread.

Solitary Cervical Spne Osteochondroma Presenting as a Hard-Left Lateral Neck Mass in a Young Lady in a Low Resource Setting: A Case Report

Spinal osteochondroma are basically of two forms, these are spinal osteochondromas in patients with multiple osteochondromas and solitary osteochondromas occurring in the spine. Osteochondromas are more prevalent among the male gender and has an age of onset between 20-30 years. This is a 27-year-old lady that was referred for plain radiograph of the cervical region on account of a hard mass on the left aspect of the neck that was slowly growing for two years duration. He patient also complained of occasional left shoulder, forearm, wrist and hand pain with occasional numbness. The plain radiography was done in both anterior-posterior and lateral projection, showed a soft tissue density fullness and an expansile missed sclerotic and lucent lesion/mass involving the spinous processes of the second to sixth cervical vertebrae. The expansile, and mixed sclerotic and lucent appearance of this area proffered the differential of a solitary cervical spinal osteochondroma. The patient had surgical excision of the tumor, and histopathologic assessment of the tumor confirmed osteochondroma. We report the radiologic finding of a case of Solitary cervical spine osteochondroma in a 27-year-old lady due to its rare nature and presentation

Low Radiation X-rays: Benefiting People Globally by Reducing Cancer Risks.

Modern medical imaging facilitates the diagnosis and treatment of human diseases. However, few people are aware of the cons of radiation exposure from medical imaging. Emerging evidence reveals that cumulative doses of radiation exposure will increase the morbidity and mortality of pertaining cancer. As a special young population, patients with adolescent idiopathic scoliosis (AIS) suffer more radiation harms from repeated diagnostic imaging, most of which can be avoided in clinical practice. Accumulating evidence highlights reduced cancer risks of radiation exposure for AIS patients with low/zero radiation imaging modalities proposed, amongst which easy conversion from anterior-posterior (AP) to posterior-anterior (PA) projection for whole-spine radiographs should be stressed. It can greatly reduce radiation doses without compromising the quality of diagnostic imaging. Tight collimation combined with PA projection can further reduce radiation harms, and need to be spread to benefit people globally.

Relationships of Reference Points, Planes and Skull Symmetry on Posterior-anterior Cephalograms in Healthy Young Adults

Background: Radiological cephalometry is an important diagnostic tool for analyzing the shape and proportions of the skull. Standardized teleradiography of the skull in posterior-anterior (PA) projection provides orientation data on the symmetry and vertical relations of the skull. The comparison of individual findings with normal values places high demands on the selection of a control group. The aim of this study was to characterize a group to be used as a standard for cephalometric comparisons. Patients and Methods: PA teleradiographs of 23 healthy young adults were analyzed. Distances from reference measuring points to the median sagittal plane and the orbital horizontal plane were made. All individuals showed ideal occlusion. None of the participants had been subjected to orthodontic therapy or craniomaxillofacial surgery. Results: The measurement results showed a high degree of lateral symmetry of the skeletal reference points and planes. Comparison of the vertical reference lines confirmed the symmetrical constitution of the facial skeleton. Conclusion: The study group is suitable for comparison with the cephalometric evaluations of other study groups.

Impact of tube angulation on radiation dose using image noise reduction technology

Abstract Objectives This study sought to evaluate the impact of tube angulation on radiation dose using image noise reduction technology in a clinical setting. Image noise reduction technology has been shown to significantly reduce radiation dose in coronary angiography in particular by reduction of radiation in cine mode. Methods In 500 coronary angiograms performed by the same operator the dose-area product (DAP) was determined. The DAP was determined for the cine mode as well as for the fluoroscopy mode. Furthermore, in the cine mode, the DAP on a per image (DAP/frame) basis was determined for the posterior-anterior projection (PA) as well as a left anterior oblique (LAO) cranial (LAO 20°/20°) and caudal (LAO 45°/−20°), right anterior oblique (RAO) cranial (RAO 20°/20°) and caudal (RAO 30°/−20°) angulations. The image intensifier area was kept constant for all angulations. Results Mean body mass index was 28.6±5.5 kg/m2. Mean total DAP was 1227±1417 cGy cm2. The mean ratio of DAP in cine mode/DAP in fluoro mode was 0.54±0.32. Mean DAP/frame in PA angulation was 5.5±3.3 (cGy cm2). Considering the cine mode, for the LAO cranial and LAO caudal angulations, the relative DAP/ frame compared to the PA angulation was 2.8±1.8 and 4.2±1.6, respectively. For the RAO cranial and RAO caudal angulations, the relative DAP/frame compared to the PA angulation was 1.7±2.2 and 1.8±1.4. Conclusions Using image noise reduction technology, radiation during fluoroscopy mode contributes more to total radiation dose than radiation during cine mode. In cine mode, the PA angulation has least radiation/ frame. The LAO caudal angulation is associated with greatest increase in radiation dose compared to the PA angulation, while LAO cranial angulation and RAO cranial and caudal angulations increase radiation dose to a lesser extent. Funding Acknowledgement Type of funding source: None

Variasi Faktor Exsposi Pada Pemeriksaan Schedel Proyeksi Anterior Posterior untuk Hasil Radiografi yang Maksimal di Rumah Sakit Al Islam Bandung

The head is an examination that is often done at each hospital, especially Posterior Anterior projection. The quality of the results of a good picture of contrast, density and detail are needed so that the exposure factor will be very influential on the head examination. The study was conducted at Al Islam Hospital in Bandung using the head phantom. Variations in kV and mAs in this study were AP projections with 64 kV and 11.2 mAs, AP schemes with 72 kV and 14.2 mAs, AP heads with 80 kV and 12.6 mAs, AP heads with 88 kV and 14, 2 mAs and AP head radiographs with 96 kV and 16.0 mAs. The maximum exposure factor value on the head phantom in anteroposterior projections based on the data is that the respondent's value has changed and only one is the same or similar from the respondent's perspective, the use of kV 64 and mAs 11.2 has a density value of the ten respondents by 94%, the value of in contrast to the ten respondents by 68%, the sharpness value of the ten respondents by 74%, and the detailed value of the ten respondents by 74%. In the use of kV 72 and mAs 14.2, the density value of the ten respondents was 42%, the contrast value of the ten respondents was 44%, the sharpness value of the ten respondents was 38%, and the retail value of the ten respondents was 38%. The use of kV 80 and mAs 12.6 has a density value of the ten respondents of 56%, the contrast value of the ten respondents by 44%, the sharpness value of the ten respondents by 40%, and the retail value of the ten respondents by 40%. In the use of kV 88 and mAs 14.2, the density value of the ten respondents was 78%, the contrast value of the ten respondents was 64%, the sharpness value of the ten respondents was 64%, and the retail value of the ten respondents was 64%. In the use of kV 96 and mAs 16.0, the density value of the ten respondents was 78%, the contrast value of the ten respondents was 76%, the sharpness value of the ten respondents was 64%, and the retail value of the ten respondents was 80%. According to the evaluation of the ten respondents expose at Al Islam Hospital Bandung, the results of the first radiograph with the exposure factor kV 64 and mAs 11.2 had the highest value. And the lowest index value of each respondent is the exposure factor kV 72 and mAs 14.2.