Anterior-posterior Projection Research Articles

Contralateral Sublaminar Approach in Lumbar Spine With Unilateral Biportal Endoscopy

Unilateral biportal endoscopy (UBE) can be used to treat common lumbar pathologies, such as synovial facet cysts, foraminal disc herniations, and foraminal stenosis via a contralateral sublaminar approach. Due to the ultra-minimally invasive technique, UBE can reduce damage to anatomical structures, thereby reducing postoperative pain and allowing faster recovery. The patient is placed prone on a Wilson frame or bolsters. Fluoroscopy is used to identify the midline and medial pedicle line in the anterior-posterior projection. Spinal needles can aid to identifying portals’ trajectory in the lateral fluoroscopic projection. The procedure is performed via 2 separate portal incisions. The endoscope is introduced through the viewing portal and the surgical instruments through the working portal. Soft tissue dissector is used to create a working area over the spinous process-lamina junction. Bony shaving and drilling start at the target area and continue medially underneath the base of the spinous process until the midline and contralateral ligamentum flavum are identified. Contralateral ligamentum flavum is excised, exposing thecontralateral thecal sac, traversing nerve root, and lateral recess. The contralateral disc space, annulus, and superior articulating process are then identified and the offending pathology can be addressed under direct visualization. Meticulous hemostasis and close attention to outflow should be maintained to reduce the risk of complications. The steps of this procedure closely resemble those of traditional microscopic “over-the-top” techniques, including the surgical instruments used through the working portal. In this video, authors present the surgical technique of the contralateral sublaminar approach in the lumbar spine with UBE.

No code machine learning: validating the approach on use-case for classifying clavicle fractures

PurposeWe created an infrastructure for no code machine learning (NML) platform for non-programming physicians to create NML model. We tested the platform by creating an NML model for classifying radiographs for the presence and absence of clavicle fractures. MethodsOur IRB-approved retrospective study included 4135 clavicle radiographs from 2039 patients (mean age 52 ± 20 years, F:M 1022:1017) from 13 hospitals. Each patient had two-view clavicle radiographs with axial and anterior-posterior projections. The positive radiographs had either displaced or non-displaced clavicle fractures. We configured the NML platform to automatically retrieve the eligible exams using the series' unique identification from the hospital virtual network archive via web access to DICOM Objects. The platform trained a model until the validation loss plateaus. Once the testing was complete, the platform provided the receiver operating characteristics curve and confusion matrix for estimating sensitivity, specificity, and accuracy. ResultsThe NML platform successfully retrieved 3917 radiographs (3917/4135, 94.7 %) and parsed them for creating a ML classifier with 2151 radiographs in the training, 100 radiographs for validation, and 1666 radiographs in testing datasets (772 radiographs with clavicle fracture, 894 without clavicle fracture). The network identified clavicle fracture with 90 % sensitivity, 87 % specificity, and 88 % accuracy with AUC of 0.95 (confidence interval 0.94–0.96). ConclusionA NML platform can help physicians create and test machine learning models from multicenter imaging datasets such as the one in our study for classifying radiographs based on the presence of clavicle fracture.

Evaluating 3D Simulation Accuracy for Breast Augmentation Outcomes: A Volumetric and Surface Contour Analysis in Chinese Patients.

The use of three-dimensional imaging in breast augmentation with silicone implants has revolutionized the surgery planning process by providing detailed visualizations of expected post-surgical outcomes. This technology enhances the decision-making process, enabling patients to choose their implants with greater confidence and ultimately leading to higher satisfaction with the postoperative outcome. This study aims to assess the accuracy of 3D imaging simulations using the Canfield Vectra XT 3D system in predicting breast augmentation outcomes in Chinese patients, focusing on volume, surface contour, breast anterior-posterior (AP) Projection, and breast internal angle. Our study analyzed female patients who received breast augmentation, documenting their preoperative and three-month postoperative conditions with 3D Vectra XT system images. Exclusions were made for patients undergoing concurrent breast surgeries or those with tuberous or ptotic breasts, due to limitations of the imaging system. Implants used were either round textured or anatomically shaped cohesive silicone gel, inserted subpectorally through trans-axillary or inframammary incisions, based on personalized evaluations. A detailed comparison between preoperative simulations and actual postoperative outcomes was conducted, focusing on volume, surface contour, AP projection, and internal angle variations. Statistical significance was determined through paired T tests, P < 0.05. In the analysis of preoperative simulations for determining postoperative outcomes in breast surgery, our study involving 42 Chinese patients, a total of 84 breasts, was conducted. The results indicated a mean volumetric discrepancy of 21.5 ± 10.3 (SD) cubic centimeters between the simulated and actual postoperative outcomes, achieving an accuracy rate of 91.9%. The root mean square deviation for the breast surface geometry was calculated to be 4.5 ± 1.1 (SD) millimeters (mm), demonstrating a low variance between the predicted and observed outcomes. The investigation found no significant variations across any specific areas of the breast surface, highlighting the uniform accuracy of the simulations across the entire breast. Additionally, the mean differences in Anterior-Posterior (AP) projection and internal angle were determined to be 8.82 ± 5.64 mm and 0.48 ± 1.91 (SD) degrees, respectively. These findings collectively attest to the efficacy of preoperative simulations in accurately predicting the postoperative physical appearance of breasts, thereby providing a valuable tool for surgical planning and improving the consultation process for patients. The Canfield Vectra XT 3D system has proven to be remarkably accurate in predicting the volumetric outcomes of breast augmentation surgery, with an accuracy rate exceeding 91.9%. It stands as a valuable tool for surgeons and patients alike, enhancing the preoperative planning process by offering a realistic preview of surgical results. This advancement not only facilitates a deeper understanding and setting of realistic expectations for patients but also strengthens the communication between patients and surgeons, ultimately leading to higher satisfaction rates with the surgical outcomes. It also emphasizes the significance of detailed documentation and consent processes in protecting against legal repercussions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Meteora sporadica, a protist with incredible cell architecture, is related to Hemimastigophora

"Kingdom-level" branches are being added to the tree of eukaryotes at a rate approaching one per year, with no signs of slowing down.1,2,3,4 Some are completely new discoveries, whereas others are morphologically unusual protists that were previously described but lacked molecular data. For example, Hemimastigophora are predatory protists with two rows of flagella that were known since the 19th century but proved to represent a new deep-branching eukaryote lineage when phylogenomic analyses were conducted.2Meteora sporadica5 is a protist with a unique morphology; cells glide over substrates along a long axis of anterior and posterior projections while a pair of lateral "arms" swing back and forth, a motility system without any obvious parallels. Originally, Meteora was described by light microscopy only, from a short-term enrichment of deep-sea sediment. A small subunit ribosomal RNA (SSU rRNA) sequence was reported recently, but the phylogenetic placement of Meteora remained unresolved.6 Here, we investigated two cultivated Meteora sporadica isolates in detail. Transmission electron microscopy showed that both the anterior-posterior projections and the arms are supported by microtubules originating from a cluster of subnuclear microtubule organizing centers (MTOCs). Neither have a flagellar axoneme-like structure. Sequencing the mitochondrial genome showed this to be among the most gene-rich known, outside jakobids. Remarkably, phylogenomic analyses of 254 nuclear protein-coding genes robustly support a close relationship with Hemimastigophora. Our study suggests that Meteora and Hemimastigophora together represent a morphologically diverse "supergroup" and thus are important for resolving the tree of eukaryote life and early eukaryote evolution.

Cervical Vertebrae Column Radiography with Suspective Fractures of the Corpus and Processus Spinosus Cervicalis at Columbia Asia Hospital Medan

Veterbra Cervicalis is a spine consisting of seven segments which have small segment bodies and large segment openings. The function of the Veterbra Cervicalis is to cover and protect the spinal nerves, which act as support for almost two-thirds of the body's weight. As for the purpose of the work write scientific This in arrange is for show fracture and abnormality on the organ being examined, to obtain image criteria that can be appropriate to the case, for know location fracture the, for straighten up diagnosis in accordance with the case. Aircraft X-ray is Wrong One equipment installation radiology which has an important role in producing X-rays and providing images of objects on X-ray film. Radiographic techniques to show the anatomy of the Cervical Vertebral Column and its abnormalities, including cervical fractures, can theoretically be done with several projections, namely AP (Antero - Posterior), Lateral, Hyperextension and Hyperflexion. After carrying out a radiographic examination of the Cervical Vertebra Column with a suspected fracture in the Anterior part of the Cervical Vertebrae Corpus -5 and Cervical Spinous Process -2 at Columbia Asia Hospital Medan, the author concluded that the projections used were Anterior Posterior (AP) and Lateral projections. In the AP projection carried out at Columbia Asia Hospital Medan, a fracture appeared in the anterior portion of the Cervical Corpus -5, and in the lateral projection, a fracture appeared in the spinous process. Cervical -2.

Applicability and robustness of an artificial intelligence-based assessment for Greulich and Pyle bone age in a German cohort.

The determination of bone age (BA) based on the hand and wrist, using the 70-year-old Greulich and Pyle (G&P) atlas, remains a widely employed practice in various institutions today. However, a more recent approach utilizing artificial intelligence (AI) enables automated BA estimation based on the G&P atlas. Nevertheless, AI-based methods encounter limitations when dealing with images that deviate from the standard hand and wrist projections. Generally, the extent to which BA, as determined by the G&P atlas, corresponds to the chronological age (CA) of a contemporary German population remains a subject of continued discourse. This study aims to address two main objectives. Firstly, it seeks to investigate whether the G&P atlas, as applied by the AI software, is still relevant for healthy children in Germany today. Secondly, the study aims to assess the performance of the AI software in handling non-strict posterior-anterior (p. a.) projections of the hand and wrist. The AI software retrospectively estimated the BA in children who had undergone radiographs of a single hand using posterior-anterior and oblique planes. The primary purpose was to rule out any osseous injuries. The prediction error of BA in relation to CA was calculated for each plane and between the two planes. A total of 1253 patients (aged 3 to 16 years, median age 10.8 years, 55.7 % male) were included in the study. The average error of BA in posterior-anterior projections compared to CA was 3.0 (± 13.7) months for boys and 1.7 (± 13.7) months for girls. Interestingly, the deviation from CA tended to be even slightly lower in oblique projections than in posterior-anterior projections. The mean error in the posterior-anterior projection plane was 2.5 (± 13.7) months, while in the oblique plane it was 1.8 (± 13.9) months (p = 0.01). The AI software for BA generally corresponds to the age of the contemporary German population under study, although there is a noticeable prediction error, particularly in younger children. Notably, the software demonstrates robust performance in oblique projections. · Bone age, as determined by artificial intelligence, aligns with the chronological age of the contemporary German cohort under study.. · As determined by artificial intelligence, bone age is remarkably robust, even when utilizing oblique X-ray projections.. · Pape J, Hirsch F, Deffaa O et al. Applicability and robustness of an artificial intelligence-based assessment for Greulich and Pyle bone age in a German cohort. Fortschr Röntgenstr 2024; 196: 600 - 606.

Reduction of Organ Absorbed Dose and Cancer Risk through Optimizing the Use of Projection in Diagnostic X-ray Examination

This study aimed to calculate and compare the estimated organ absorption dose, risk of cancer due to exposure, and dose received by the gonads for women and men in radio diagnostic examinations with different projections. Radiographic examination of the abdomen (with anterior-posterior (AP) and posterior-anterior (PA) projections) and lumbar vertebrae (with anterior-posterior projection (AP), Right posterior-anterior oblique (RPO), and Left posterior-anterior oblique (LPO)), were performed. Software based on the Monte Carlo program has been used to calculate the estimated absorbed dose of the organ, the risk of cancer due to exposure, and the dose received by the gonads with different projections. The results showed that the PA projection on abdominal examination resulted in lower absorbed doses for the colon wall, liver, pancreas, and small intestine wall compared to the AP projection. The AP projection resulted in a higher absorbed dose than the oblique projection on the lumbar vertebral examination. RPO and LPO projections on lumbar spine examination produce different absorbed doses in organs. The colon wall, kidneys, pancreas, and prostate in men received lower doses using LPO, and the bladder, liver, ovaries (women), small intestine wall, and uterus in women received lower doses using projected RPO. The risk of cancer due to radiation exposure on abdominal examination is 35%-51% reduced using the PA projection, and on examination of the lumbar spine 40%-45% is reduced using the LPO projection. The dose received by the gonads showed that the ovarian dose reduction was 54% using the abdominal PA projection and 11% using the lumbar RPO. The dose reduction in the testicles was shown to be significant with the use of the abdominal PA projection.

Validation of the supinator fat pad sign in radial head and neck fractures.

To assess the displacement of the supinator fat pad in radial head and neck fractures and to validate its significance. One hundred two adult patients from the Royal Orthopaedic Hospital, Birmingham, United Kingdomand Sultan Qaboos University Hospital, Muscat, Omanwith confirmed radial head and/or neck fractures were included. Fractures were classified using the Mason-Johnston classification. The displacement of the supinator fat pad from the radius was measured on anterior-posterior (AP) and lateral radiographs and correlated to fracture classification. The supinator fat pad was on average displaced by 10.6 mm and 13.8 mm from the radius on AP and lateral radiographs, respectively. The displacement of the fat pad progressively increased between non-displaced (Mason I) and severely comminuted (Mason III) fractures on both the AP (10.25 to 14.25 mm) and lateral (12.70 to 16.00 mm) projections. The progression of displacement on AP (p = 0.016) and on lateral (p = 0.007) projections was statistically significant. Fracture dislocation was not associated with increased fat pad displacement. The supinator fat pad sign is a useful adjunct in the assessment of radial head and neck fractures.

STUNTING BONE AGE EXAMINATION IN STUNTING CHILDREN IN THE RADIOLOGY INSTALLATION OF SIJUNJUNG HOSPITAL, WEST SUMATRA

Bone age maturity is a key component in evaluating a child's growth. Assessment of bone maturity is determined by measuring "Bone Age", namely an X-ray examination of the left wrist bone. Ossification of trabecular bone occurs in a predictable pattern, so that assessment of bone maturity can be made at several ossification centers and then compared to standard radiographic images for males and females. The results of the radiographs are compared with the individual's chronological age as an indicator of the speed of growth, using the ± SD reference it can be concluded that it is in the late or normal category. Examination of a single X-ray on the representative left hand to assess the center of ossification so as to avoid radiation exposure for radiographic examination of all bones. Assessment of hand radiographic analysis can show a correlation with facial growth during puberty. This research is a qualitative descriptive research method with an observational study, conducted on January 27 2023 at the radiology installation of Sijunjung Hospital with a population of stunted children with a sample of seven stunted children, data collection by examining the left manus anterior posterior projection after that the radiograph results evaluated by a radiologist. The results showed that there were three stunted children who did not experience delays in bone age maturity, namely one boy aged 5 years, one boy aged 11 years and one girl aged 13 years and there were four children who were stunted. delayed bone age maturity, namely one girl aged 10 years, two boys aged 10 years and one boy aged 15 years so that further research needs to be done for the factors causing bone age maturity in stunted children.

Aesthetic Implications of Bilateral Profunda Artery Perforator Flaps on Thigh and Buttock Proportions.

The profunda artery perforator (PAP) flap has emerged as an excellent secondary option for autologous breast reconstruction. Despite the increased acceptance, potential secondary benefits concerning aesthetic proportions of proximal thigh and buttock at the donor site have never been systematically investigated. A retrospective review of 151 patients who underwent breast reconstruction with horizontally designed PAP flaps (292 flaps) from 2012 to 2020 was performed. Patient characteristics, complications, and numbers of revision surgeries were collected. In bilateral reconstructions, pre- and postoperative standardized patient photographs were analyzed to identify postoperative changes in proximal thigh and buttock contour. The patients' own perception of postoperative aesthetic changes was determined by an electronic survey. The patients had a mean age of 51 and a mean body mass index of 26.3 kg/m2. The most common complications were minor and major wound complications affecting 35.1% of patients, followed by cellulitis (12.6%), seroma (7.9%), and hematoma (4.0%). A total of 38 patients (25.2%) underwent revision of the donor site. After reconstruction, patients were found to have aesthetically improved proximal thigh and buttock proportions, indicated by a wider thigh gap (thigh gap-hip ratio: 0.05 ± 0.04 vs. 0.13 ± 0.05, p < 0.0001) and reduction in lateral thigh-to-buttock ratio (0.85 ± 0.05 vs. 0.76 ± 0.05, p < 0.0001). Among the 85 patients who responded to the survey (56.3% response rate), 70.6% felt that PAP surgery had aesthetically either improved their thigh contour (54.12%) or not changed it (16.47%), whereas only 29.4% reported that the surgery negatively impacted their thigh contour. PAP flap breast reconstruction leads to improved aesthetic proportions of the proximal thigh and buttock. This approach is ideal for patients with ptotic tissue of the inferior buttocks and medial thigh, a poorly defined infragluteal fold, and inadequate anterior-posterior buttock projection.

Congenital Anterior Dislocation of the Sacrococcygeal Bone in a Newborn.

We present a case of a child who was transported to the Neurosurgery Clinic from another hospital for the purpose of performing a surgical procedure of the spinal myelomeningocele. On the first day of the stay, a set of tests was performed, including an anterior-posterior (AP) projection X-ray, which clearly showed a developmental defect in the lumbar-sacral section of the spine. In the follow-up physical examination, there was a depression of the skin on the right side of the surgical scar after closing the open myelomeningocele. In the follow-up MRI of the lumbar-sacral section, an extremely rare congenital anterior dislocation of the sacrococcygeal bone was unexpectedly visualized. Despite recommendations for further diagnostics, the patient did not attend the required follow-up examinations. In the final section, we provide a general summary of the literature on rare developmental defects of the spine in children.

D162. Aesthetic Implications of the Profunda Artery Perforator Flap on Thigh And Buttock Proportions

PURPOSE: Profunda artery perforator (PAP) flaps are a secondary option for autologous breast reconstruction when abdominal donor sites are not available. The goal of this study was to investigate the impact of PAP flap reconstruction on aesthetic proportions of the proximal thigh and buttock. METHODS: A retrospective review of 151 patients who underwent PAP flap breast reconstruction (292 flaps) from 2012-2020 was performed. Patient characteristics and postoperative complications were recorded. Pre- and postoperative standardized photographs were analyzed to identify postoperative changes to thigh and buttock contour. The patients’ perception of postoperative aesthetic changes was determined by an electronic survey. RESULTS: The patients’ mean age was 51 years and mean BMI was 26.3 kg/m2. Complications included major and minor wound complications (35.1%), cellulitis (12.6%), seroma (7.9%) and hematoma (4.0%). After reconstruction, patients were found to have aesthetically improved proximal thigh and buttock proportions, indicated by a wider thigh gap (thigh gap-hip ratio: 0.05±0.04 vs. 0.13±0.05, P < 0.0001) and reduction in lateral thigh-to-buttock ratio (0.85±0.05 vs. 0.76±0.05, P < 0.0001). Among the 85 patients who responded to the survey (56.3 % response rate), 70.6% felt that PAP surgery had aesthetically either improved (54.12%) or not had an impact on their thigh contour (16.47%), whereas only 29.4% reported a negative impact on their thigh contour. CONCLUSION: PAP flap breast reconstruction improves aesthetic proportions of the proximal thigh and buttock. This approach is ideal for patients with ptotic tissue of the inferior buttocks and medial thigh and inadequate anterior-posterior buttock projection.

Geometric Morphometric Analysis of the Human Hand Morphology Based on X-ray Imaging

Currently, in humans, the ratio of the index and ring fingers (2D:4D ratio) determines the morphological type of the hand: type 1 or radial (2D&gt;4D), type 2 or neutral (2D=4D), type 3 or ulnar (2D&lt;4D). However, the above differences do not allow for morphological verification of the hand shape as a whole.The aim of the study was to inspect the hand shapes depending on its morphology based on radiographical images with geometric morphometric methods.Material and methods. Geometric morphometry included an analysis of the right hand shape described by 20 landmarks located on digital radiographic images (anteriorposterior projection) in 50 males and 50 females. Each hand was classified according to whether the index finger was longer, equal to, or shorter than the ring finger by visual assessment.Results. The study revealed differences between the hand shapes in the transverse direction, namely, the hands of the ulnar type (U) were wider, while the hands of the radial type (R) were narrower. The hands of neutral shape, unlike the other two types, were more oval in shape. In average, the hand shape depended on the morphological type. The most pronounced shape transformations were due to the geometry of the metacarpal bones in the transverse direction, and due to the geometry of the II, IV and V fingers in the longitudinal direction. Intergroup differences in width were revealed between the group of hands of radial (R)-neutral (N) types and ulnar (U) type, and in length between the group of hands of radial (R)-ulnar (U) types and neutral (N) type. The allometry of the hand shape was minimal.Conclusion. The results of the study demonstrate the potentials of geometric morphometry for analysis of the human hand shapes and their variability depending on the morphological type.

Implementasi Pemeriksaan Lumbosacral pada Kasus Scoliosis di Instalasi Radiologi BLUD Rumah Sakit Umum Daerah Cut Nyak Dhien Meulaboh

The aim of this study was to find out how the implementation of the lumbosacral examination in cases of Scoliosis and how to describe the quality of radiographic images on lumbosacral examination using Anterior Posterior (AP) Projection, Lateral Projection, and Anterior Posterior Projection bending left and right in terms of detail and sharpness. This study was conducted with three exposures to one patient who was diagnosed with lumbosacral scoliosis using the same distance but with different projections. The results of this study are in the form of lumbosacral radiographs and distribution frequency tables of ten radiographer respondents. The results showed that the lumbosacral examination in cases of scoliosis at the Radiology Installation BLUD, Cut Nyak Dhien Hospital, Meulaboh, West Aceh can use three different projections, namely anterior posterior projection, lateral projection and anterior posterior bending left right projection. The quality of the lumbosacral radiograph images produced in cases of scoliosis is clear and good in detail and has a sharpness level from the distance, patient movement, and the use of the viewing box.

Facial masculinization surgery

Facial masculinization surgery

Mandibular symmetry on posterior-anterior cephalograms of neurofibromatosis type 1 patients with facial plexiform neurofibroma.

Neurofibromatosis type 1 (NF1) is an is an autosomal dominant heritable tumor predisposition syndrome.. Peripheral nerve sheath tumors (PNST) are a hallmark of NF1. Plexiform neurofibromas (PNF) are neoplasms that are characteristic of NF1, often causing disfiguring effects (e.g., on the face), and are considered precancerous lesions. Previous studies have shown that facial PNF (FPNF) have an impact on the shape of facial bones. This study examines deviations of mandibular symmetry from cephalometric reference planes considering the topography of FPNF. The posterior-anterior (PA) cephalograms of 168 patients with NF1 were examined. We compared three groups: patients with FPNF (n=74), with disseminated cutaneous neurofibroma (DNF (n=94)), and control subjects without NF1 (n=23). The PNF group was subtyped with respect to facial PNST type and location. Typical mandibular cephalometric reference points were determined (condyle, antegonion, and menton). The skeletal measurement points of the mandible in FPNF patients often differ significantly from those of the DNF group. It has been proven that typical asymmetries of the median-sagittal measurement points are indicators of PNF. Differences within the trigeminal tumor spread patterns are indicated in the measured values. A local tumor effect (PNF) on the relation of the measurement points to the reference planes is made plausible by the study results. The investigations prove that tumor type (FPNF) and the number of FPNF affected branches of the trigeminal nerve may correlate with significant deviations of mandible from symmetry on PA projections. The presented study shows that characteristic patterns of mandibular deformity can be measured on standardized radiographs in NF1 patients with FPNF. Mandibular deformities imaged on standardized radiographs may be initial indicators of a previously unrecognized NF1. Tumor-associated alterations of the mandible should be considered in the classification systems of pathognomonic, diagnostically pioneering osseous findings in NF1. The radiological findings provide clues for planning mandibular osteotomies in NF1 patients, especially for assessing facial regions typically highly vascularized by tumor spread. Furthermore, the radiological findings are an indication of a tumor potentially invading and destroying adjacent masticatory and mimic muscle, findings that may have an influence on surgical measures (function, aesthetics, and wound healing).

Determination of spatial position of tibial graft using X-ray images after anterior cruciate ligament reconstruction

Background/Aim. Anterior cruciate ligament reconstruction is one of the most commonly performed knee surgeries in young adults. The success of this procedure largely depends on the proper formation of the tunnel, which is obtained by drilling the tibia and which serves to position and fix the graft. The aim of the study was to present a method for determining the spatial position of the graft based on only two standard X-rays. Methods. The study was performed on a group of 15 patients in whom the developed software applied the measurement of the angle of the tunnel in the tibia based on the selection of characteristic points on two standard X-rays of the knee (anterior-posterior and lateral projection). The obtained results were compared with the results of measuring the angle of the tunnel in the tibia on knee images by computed tomography (CT) in all patients. Results. The drilling angle measured in CT scans was, on average, some-what greater (59.07? ? 5.61?) than the angle measured by applying a developed application (58.65? ? 5.89?). The obtained results indicated minimal differences without statistical significance in the measurements of the angle of the tunnel in the tibia using the developed software and on CT images (Wilcoxon test: Z = -1.363; p = 0.173). Conclusion. The presented method and developed software are suitable for everyday clinical applications in terms of precision and usability and can be used to assess the position of tunnels in the tibia in the process of determining the success of surgery or in preparing patients for revision surgery.

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.&#x0D; 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.