Conventional Radiographic Examination Research Articles

The value of studying the cervical spine in craniofacial asymmetries

The relationship between facial asymmetry and cervical anomaly is rarely mentioned in the diagnosis of dento-maxillo-facial orthopaedics. It is regrettable that the study of the cervical spine is often ignored in the etio-pathogenesis of these dysmorphoses, particularly in cases of facial asymmetry. The aim is twofold: to encourage orthodontists and maxillofacial surgeons to make a systematic study of the cervical spine in craniofacial dysmorphoses and in particular craniofacial asymmetries, without claiming that they are becoming specialists in cervical spine pathology, and to introduce the necessary training in malformations of this anatomical region as part of the orthodontist specialisation curriculum. Conventional radiographic examinations can detect abnormalities of the cervical spine and cervico-occipital hinge. These anomalies can be clarified by additional radiographic exploration, conebeam, CT scan or others views. Some craniofacial, facial and dentoalveolar asymmetries are caused by abnormalities of the cervico-occipital hinge. Conventional radiological examinations prescribed in dento-maxillo-facial orthopaedics can be used to detect unrecognized spinal anomalies and inform patients or parents, thereby ensuring the practitioner's responsibility. The three components-atlas, axis and occipital-are confused in a complex embryological process that explains the polymorphism of malformations in this region. Any vertical and/or transverse facial and dento-alveolar asymmetry requires systematic investigation of the cervical spine as a whole and of the cranio-spinal joint in particular in search of any abnormalities.

Assessment of Reason for Exam Imaging Reporting and Data System (RI-RADS) in inpatient diagnostic imaging referrals

ObjectivesTo test the Reason for Exam Imaging Reporting and Data System (RI-RADS) in assessing the quality of radiology requests in an Italian cohort of inpatients; to evaluate the interobserver reliability of RI-RADS.MethodsA single-center quality care study was designed to retrospectively identify consecutive radiology request forms for computed tomography, magnetic resonance imaging, and conventional radiography examinations. One radiologist scored the requests using the RI-RADS. The association between RI-RADS and clinical request variables (urgent request, on-call requests, indication for imaging, requesting specialty, imaging modality, and body region) was evaluated. We calculated interobserver agreement between four readers in a subset of 450 requests.ResultsWe included 762 imaging requests. RI-RADS grades A (adequate request), B (barely adequate request), C (considerably limited request), D (deficient request), and X were assigned to 8 (1%), 49 (7%), 237 (31%), 404 (53%), and 64 (8%) of cases, respectively. In the multivariate analysis, the indication for imaging, body region, and requesting specialty significantly influenced the RI-RADS. Indications for imaging with a high risk of poor RI-RADS grade were routine preoperative imaging and device check requests. The upper extremity was the body region with the highest risk of poor RI-RADS grade. Requesting specialties with a high risk of poor RI-RADS grade were cardiovascular surgery, intensive care medicine, and orthopedics. The analysis of the interobserver agreement revealed substantial agreement for the RI-RADS grade.ConclusionThe majority of radiology exam requests were inadequate according to RI-RADS, especially those for routine imaging. RI-RADS demonstrated substantial reliability, suggesting that it can be satisfactorily employed in clinical settings.Critical relevant statementThe implementation of RI-RADS can provide a framework for standardizing radiology requests, thereby enabling quality assurance and promoting a culture of quality improvement.Key PointsRI-RADS aims to grade the completeness of radiology requests.Over half of the imaging requests were RI-RADS D grade; RI-RADS demonstrated substantial reliability.Most radiology requests were inadequate and RI-RADS could classify them in clinical practice.Graphical

Nilai Entrance Skin Dose Tiroid antara menggunakan Thyroid Shield dan tanpa Thyroid Shield pada Pemeriksaan CT Scan Kepala

Background: CT scans have a much greater dose than conventional radiographic examinations. The thyroid organ is an organ that is sensitive to radiation which is located near the head, precisely in the inferior part of the head so that when a CT scan of the head is carried out, the thyroid organ will be exposed to radiation. The aim of this study was to determine the difference in thyroid skin dose entry value between using a thyroid shield and without a thyroid shield on a head CT scan.Methods: This study is a type of quantitative research with a pre-experimental design. The object of research is Entrance Skin Dose (ESE) of ThyroidOrgan on non-contrast head CT Scan examination. The research location is at the Radiology Department at the Regional General Hospital Prof. Dr. Margono Soekarjo Purwokerto. Sample data number is 50 people (25 samples of non-contrast head CT scans without thyroid shield, and 25 samples of non-contrast head CT scans with thyroid shield. Data was obtained by measuring the radiation dose using a dosimeter placed over the thyroid area during a non-contrast CT scan between using a thyroid shield and without using a thyroid shield. Data analysis was performed using statistical tests Results: The results of measuring the radiation dose to the samples showed that the average radiation dose to the skin surface of the thyroid organ on a non-contrast CT scan without using a thoracic shield was 884.96 µSv and using a thyroid shield was 428.64 µSv. This shows that the average radiation dose from the skin surface of the thyroid organ decreased by 456.32 µSv (51.56%).Conclusions: There is a significant difference in the amount of radiation dose to the surface of the skin of the thyroid organ in non-contrast head CT scans between using a thyroid shield and without using a shield with a dose reduction of 51.6% of the radiation dose without using a thyroid shield.

Plain radiography has a role to play in current clinical practice in Western Switzerland

AimThe aim of the study was to investigate the current role of conventional radiography examinations in Western Switzerland and the main clinical indications required to justify the use of this imaging examination. MethodsEthical approval was obtained from Vaud Ethics committee (Ref 2020–00311). An online questionnaire was specifically designed and implemented on the data collection tool LimeSurvey composed of two parts: a) to characterise the participants’ profile and their institutions and b) 169 projections for the different anatomical area (upper and lower limbs, pelvis, skull, spine, thorax, abdomen) were presented to collect data about the frequency and main clinical indications. Statistical analysis was performed using the software IBM SPSS® (Statistical Package for the Social Sciences) version 26. ResultsRadiographers from 60% (26/43) of the invited institutions participated in this survey, mainly from Vaud region. The upper and lower limbs were the most commonly examined by using conventional radiography mainly for trauma and degenerative disorders. The thorax was also an anatomical area commonly explored by X-rays, so were the spine (cervical and lumbar lateral). The skull radiographs were rarely performed in clinical practice and some of the projections were not being used, namely Hirtz, Tangential Nose Bones, Worms and Caldwell's views. ConclusionsPlain radiography is being used in clinical practice mainly for appendicular skeleton studies and for trauma and degenerative pathologies. Adaptations in radiographers’ education and training and other healthcare professionals are needed to provide the judicious use of data that radiographs can give to better manage the patients’ imaging pathway.

Surface of a tapered implant

The choice of implant shape and size is an important part of the treatment plan procedure in order to obtain an implant that is sta-ble in masticatory function and aesthetic function. The use of implants with a tapered design and surface modification would improve the ultimate stability in low density bone. A comprehensiveand accurate radiographic examination is also an import-ant aspect of dental implant treatment planning. This article is aimed to present things about taperedinternal implants starting from indications, shape and dimensions, design, surface characteristics of the implant and drilling guide and selection of the appropriate type and radiographic technique to produce appropriate diagnostic information. So, with the limited facilities of modern radiographic images inIndonesia, conventional radiographic examinations with several projections can be used as an option to obtain optimal diagnostic information according to existing cases.
 Keywords: tapered implant, dental implant, dental implant radiography.

PROSEDUR PEMERIKSAAN RADIOGRAFI HIP JOINT POST-OPERASI TOTAL HIP ARTHOPLASTY

ABSTRACT
 Background: Conventional radiographic examination of the hip joint post-operative Total Hip Arthoplasty aims to propose a prosthesis on the Hip Joint. Parameters assessed with AP Pelvis Projection include leg length, center of horizontal rotation, center of vertical rotation. Acetabular inclination, femoral stem positioning, and cement mentle thickness can be assessed on AP Unilateral Hip Projection and AP Pelvis Projection, whereas Acetabular anteversion can only be seen with inferosuperior axiolateral projections. Conventional radiographic examination of the hip joint after Total Hip Arthoplasty surgery at the Radiology Installation of Tidar Magelang Hospital was only carried out by AP Pelvis Projection.
 Method: This research type is qualitative with case study approach. Data collection methods consisted triangulation method of observation, interview and documentation. Research subject consist 3 radiology technologist, 1 specialist doctor, and 1 radiology doctor. Collected data will be analyzed with interactive technique transformed into transcript and then reducted. After that the data will be shown as quotation. Based on data and literature study, author will conclude.
 Result: Radiographic exam of hip joint post-operation Total Hip Arthoplasty in Radiology Departement of RSUD Tidar Magelang is done in accordance to standard procedure of only using AP Pelvic projection. This is done to acquire radiographic image of both sides of the hip joints, the whole prosthetic component, and reducing the radiation received. Central point set on the center of symphisis pubic, with area of collimation as wide as the detector to acquire image of the whole prosthetic. Without lateral projection the lateral view of the prosthetic cannot be acquired causing the absence of the radiographic images of both acetabular anteversion and the acetabular retroversion. Causing the angle of acetabular component of the prosthetic cannot be measured. Resulting in the loss additional information.
 Conclusion: AP Pelvic projection is in accordance to standard procedure of Radiology Departement of RSUD Tidar Magelang, specialist doctor’s request, and had shown the radiographic image of the whole prosthetic component. From author’s opinion, it is best that lateral projection still be done to acquire complete information of the radiographic evaluation of post-operation Total Hip Arthoplasty.

Assessment of an artificial intelligence aid for the detection of appendicular skeletal fractures in children and young adults by senior and junior radiologists.

As the number of conventional radiographic examinations in pediatric emergency departments increases, so, too, does the number of reading errors by radiologists. The aim of this study is to investigate the ability of artificial intelligence (AI) to improve the detection of fractures by radiologists in children and young adults. A cohort of 300 anonymized radiographs performed for the detection of appendicular fractures in patients ages 2 to 21 years was collected retrospectively. The ground truth for each examination was established after an independent review by two radiologists with expertise in musculoskeletal imaging. Discrepancies were resolved by consensus with a third radiologist. Half of the 300 examinations showed at least 1 fracture. Radiographs were read by three senior pediatric radiologists and five radiology residents in the usual manner and then read again immediately after with the help of AI. The mean sensitivity for all groups was 73.3% (110/150) without AI; it increased significantly by almost 10% (P<0.001) to 82.8% (125/150) with AI. For junior radiologists, it increased by 10.3% (P<0.001) and for senior radiologists by 8.2% (P=0.08). On average, there was no significant change in specificity (from 89.6% to 90.3% [+0.7%, P=0.28]); for junior radiologists, specificity increased from 86.2% to 87.6% (+1.4%, P=0.42) and for senior radiologists, it decreased from 95.1% to 94.9% (-0.2%, P=0.23). The stand-alone sensitivity and specificity of the AI were, respectively, 91% and 90%. With the help of AI, sensitivity increased by an average of 10% without significantly decreasing specificity in fracture detection in a predominantly pediatric population.

ESTIMASI DAN AUDIT DOSIS RADIASI PASIEN PADA PEMERIKSAAN RADIOGRAFI KONVENSIONAL TORAKS PA DENGAN TEKNIK HIGH KVP

Research about estimation and dose audit of patients' radiation on examination about thorax PA conventional radiography with high kV technique has been conducted in MRCCC Siloam Hospitals Semanggi. The research has been done on 305 patients aged around 15 years old who got thorax examinations. They consist of 129 male patients and 176 female patients. The characteristics of patients' age are between 18-86 years old, and their average age is 44.2 years old. Their weight range is between 38-120 kg, and their average weight is 66.8 kg. The thorax PA conventional radiography examination uses kVp 125, and the content of mAs is 0.5-1.4 mAs, with an average of 0.8 mAs. The dosage of patients with INAK and ESAK are counted from the outcome similarity graph of the radiation from the X-ray craft. Data analysis shows a linear increase of INAK and ESAK with a linear correlation consecutive of 0.9969 and 1 toward the rise in mAs. The higher the mAs, the higher the patient's dose of radiation also becomes bigger because mAs represent the quantity of radiation so that the amount of photons produced by the X-ray tube becomes bigger. The research result shows that the average increase of INAK and ESAK consecutive is 0.11 mGy and 0.15 mGy, with a typical value of INAK at 0.1 mGy and ESAK at 0.14 mGy. The average ESAK on the research is compared with some reference data, and the result of ESAK in MRCCC Siloam Hospitals Semanggi is under some reference data. The dose audit is the establishment of typical value, and it is compared with national DRL based on the regulation of the head of BAPETEN about stipulation of Indonesia Diagnostic Reference Level Value no. 1211/K/V/2021 on thorax PA examination. The examination of thorax PA about INAK and ESAK national DRL consecutive is 0.3 mGy and 0.4 mGy. Therefore, the result of the dose audit about establishing typical value on the study about thorax PA conventional radiography in MRCCCC Siloam Hospitals Semanggi is under national DRL. The follow-up of the dose audit is to keep the examination protocol and evaluate typical values periodically. The high kVp technique on the conventional radiography examination can reduce the patient's radiation dose. Keywords: Radiation Dose, Conventional Radiography, Thorax PA. High kVp Technique, Diagnostic Reference Levels

A rare case of oxidized zirconium - All polyethylene tibia unicompartmental arthroplasty failure: A case report.

Oxidized zirconium (Oxinium) implants has been claimed as the best material in terms of wear reduction. However, longevity of an all polyethylene uni knee arthroplasty (UKA) has been a long debate. We reported a rare case of 74 year old female who was performed all polyethylene UKA 6 years prior and fell 3 months prior. After the incident, patient was wheel-chair ridden afterwards. There was no evidence of fracture upon conventional radiography examination. Conversion of UKA to total knee replacement (TKA) was performed and patient was able to walk with aid after the surgery. The failed Oxinium all polyethylene UKA failure in this case is suspected due osteoarthritis progression.

INFORMASI DIAGNOSTIK GAMBARAN RADIOGRAF CERVICAL HASIL MULTIPLANAR RECONSTRUCTION CT-SCAN KEPALA

ABSTRACT&#x0D; Introduction : Data at Kenyatta National Hospital (KNH) from 2012 to 2016 recorded that there were 1,432 patients with a head injury diagnosis. Of the patients diagnosed with moderate or severe head injury, 11 (3.07%) patients had head and neck injuries. The clinical pathway in the diagnosis of head injury, CT-Scan of the brain (preferably with the inclusion of the cervical vertebrae) is now the rule in assessing traumatic brain injury. At the Radiology Installation of the Salatiga City Hospital, a head CT scan with a head injury diagnosis used a scan of the area from cervical 7 to the vertex, then cervical radiographs were made using MPR.&#x0D; Methods : This study uses a qualitative method with a case study approach. Data collection was carried out in March 2020 by direct observation, in-depth interviews, and documentation studies.Results : Patients diagnosed with CKS and CKB were shown cervical MPR. This MPR image has no superposition, which usually shows cervical 1 and 2 superposition with the mandible even at an angle, and in the lateral projection, cervical 7 superposition with the shoulder. The disadvantage is that the radiation dose received by the patient increases, but on radiological examination there is a justification principle, namely even though using a CT-Scan with greater radiation, the benefits obtained are also greater. In addition, burst fractures can be seen on cervical radiographs from MPR. There are fractures in trauma victims that are not fully demonstrated on radiographs at cervical 1 to cervical 2, cervical 6 to 7 cervical levels, and most involve the transverse process because the patient is uncooperative. Helical CT scanning can depict significant fractures that cannot be demonstrated on conventional radiographs and should be added to the initial screening for suspected cervical trauma.Conclusion : The cervical MPR image aims to obtain four cervical projections, namely AP, lateral, right oblique, and left oblique without conventional projections with the aim of minimizing movement in patients who are at risk of aggravating spinal cord injury. Diagnostic information from MPR results is to obtain structural visualization. specific, determine the extent of the lesion, localize the lesion and bone fragments. However, the radiation dose received is greater than conventional radiographic examinations.

Deep Learning for Detection of Pulmonary Metastasis on Chest Radiographs.

Background A computer-aided detection (CAD) system may help surveillance for pulmonary metastasis at chest radiography in situations where there is limited access to CT. Purpose To evaluate whether a deep learning (DL)-based CAD system can improve diagnostic yield for newly visible lung metastasis on chest radiographs in patients with cancer. Materials and Methods A regulatory-approved CAD system for lung nodules was implemented to interpret chest radiographs from patients referred by the medical oncology department in clinical practice. In this retrospective diagnostic cohort study, chest radiographs interpreted with assistance from a CAD system after the implementation (January to April 2019, CAD-assisted interpretation group) and those interpreted before the implementation (September to December 2018, conventional interpretation group) of the CAD system were consecutively included. The diagnostic yield (frequency of true-positive detections) and false-referral rate (frequency of false-positive detections) of formal reports of chest radiographs for newly visible lung metastasis were compared between the two groups using generalized estimating equations. Propensity score matching was performed between the two groups for age, sex, and primary cancer. Results A total of 2916 chest radiographs from 1521 patients (1546 men, 1370 women; mean age, 62 years) and 5681 chest radiographs from 3456 patients (2941 men, 2740 women; mean age, 62 years) were analyzed in the CAD-assisted interpretation and conventional interpretation groups, respectively. The diagnostic yield for newly visible metastasis was higher in the CAD-assisted interpretation group (0.86%, 25 of 2916 [95% CI: 0.58, 1.3] vs 0.32%, 18 of 568 [95% CI: 0.20, 0.50%]; P = .004). The false-referral rate in the CAD-assisted interpretation group (0.34%, 10 of 2916 [95% CI: 0.19, 0.64]) was not inferior to that in the conventional interpretation group (0.25%, 14 of 5681 [95% CI: 0.15, 0.42]) at the noninferiority margin of 0.5% (95% CI of difference: -0.15, 0.35). Conclusion A deep learning-based computer-aided detection system improved the diagnostic yield for newly visible metastasis on chest radiographs in patients with cancer with a similar false-referral rate. © RSNA, 2021 Online supplemental material is available for this article.

A possible case of ameloblastoma in an adult male from the early 20th century Coimbra, Portugal

ObjectiveThis article discusses the differential diagnosis of an unusual lesion found in the mandible of an adult male individual (late 19th to early 20th century). MaterialsA cranium from the Identified Skulls Collection Escolas Médicas of the University of Coimbra, Portugal. MethodsMacroscopic analysis, conventional radiography. ResultsMacroscopically, a conspicuous osteolytic lesion was identified in the middle vestibular area of the mandible. The conventional radiography examination revealed a multilocular and non-expansive lesion, with undefined contours and irregular walls. ConclusionsThese characteristics are compatible with a benign lesion, possibly an ameloblastoma or an odontogenic keratocyst. SignificanceThe present work contributes substantially to the knowledge of the development of cystic and tumour lesions in the past and generates a broader body of knowledge about these lesions. LimitationsDestructive methods were not authorized. Suggestions for Further ResearchIn the future, computed tomography scans and 3D reconstruction analysis, not performed in the current study, may add new and valuable information.

Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Axial Spondyloarthritis 2021

Objective. Recommendations for spondyloarthritis are made to provide guidelines in diagnosis establishment, therapy, and monitoring of axial spondyloarthritis cases.Method. Literature searches were conducted online. The drafting team determines the levels of evidence (LOE) and grades of recommendation (GOR). After conducting a discussion, each recommendation that has been agreed upon by the drafting team is then classified based on the levels of evidence and grades of recommendation. The final step in the preparation of these recommendations is to determine the level of agreement (LOA) on each recommendation carried out by a team of panelists who have been appointed by IRA.Results. Twenty recommendations regarding axial spondyloarthritis were established. Strong recommendations or GOR A include: Ax-SpA diagnosis can be made according to the 2010 ASAS criteria, or the 1984 modified New York criteria specifically for the US; conventional radiographic examinations and MRI of the sacroiliac joints and vertebrae may be used as evaluators of disease activity and predictors of therapeutic response, as well as patients who do not respond to NSAIDs (within 4 weeks) can be administered a combination of NSAIDs and anti-TNF, and if it is not possible, a combination of NSAIDs and anti-IL-17A (Secukinumab, Ixekizumab).Conclusion. These recommendations provide a direction for clinicians to diagnose and manage spondyloarthritis.

Home mobile radiography service in the COVID-19 era.

Demographic changes in the Western world linked to the increase in the elderly population, life expectancy and above all cancer patients and chronically ill patients, often entrusted to home care or in healthcare residences, highlight an exponential increase in requests for diagnostic tests at home. Conventional radiographic examinations, such as thoracic, musculoskeletal and abdominal images are the most requested and are important first level diagnostic tests. To date and, in particular, in times of COVID-19 emergency, these patients need to be transferred to the hospital to perform radiological examinations which involve an increase in costs for the health system and an increased risk for the health of these patients, already often debilitated and immunocompromised. This article discussed the benefits of taking conventional chest x-rays directly at the patient's home.

Inferior alveolar nerve paraesthesia after overfilling into the mandibular canal, confirmed by cone-beam computed tomography: a case report

The filling material should be restricted to the root canal, and not extend to the periradicular tissues. Overextension occurs when there is an overflow of gutta-percha and sealer, whereas overfilling refers to the overflow only of sealer beyond the apical foramen. Both may cause several negative clinical consequences. Nevertheless, an accurate diagnosis of where they occurred cannot always be performed by conventional radiographic examination, because of the two-dimensional aspect of the image. This paper describes a clinical case of labiomandibular paraesthesia after overfilling into the mandibular canal (MC), as diagnosed by cone-beam computed tomography (CBCT), later used to perform the treatment planning. A 34-year-old Caucasian female patient sought a private dental clinic complaining of pain in the right mandibular posterior region. After taking the anamnesis and performing clinical and radiographic exams, the patient was diagnosed with pulp necrosis in the second right mandibular molar, and underwent root canal treatment. The final radiography showed overextension or overfilling, probably into the MC. About 2 hours after the procedure, the patient reported paraesthesia of her lower right lip and chin. A CBCT confirmed a small overfilling into the MC. For this reason, vitamin B12 was prescribed as the first treatment option. After 7 days, the patient reported a significant decrease in paraesthesia, and was completely normal after 15 days. This case report shows that CBCT is an effective radiographic diagnostic tool that can be used as an alternative in clinical cases of labiomandibular paraesthesia caused by overextension or overfilling. Keywords Endodontic treatment; Overfilling; Paraesthesia; Conebeam computed tomography.

ODONTOMA Not Otherwise Specified (NOS)

Twenty-year-old female leucoderm patient V.G.P. sought the dental office reporting discomfort during chewing in the left retromolar region. During the anamnesis and extraoral clinical examination, no changes were observed. In the intraoral examination during palpation, the patient reported mild discomfort in the region referred to above. The conventional periapical radiographic examination revealed a radiolucent area with well-delimited radiopaque halo circular shape in the distal region of the tooth 38 adhered in the coronary portion with radiopaque image suggestive of a tooth in formation. In view of this finding, a panoramic radiograph was requested to evaluate the area. During the surgical procedure for removal of the included tooth and the intraosseous lesion, a puncture was performed, which had a negative result. Material was sent for histopathologic examination. The diagnostic hypotheses were ameloblastic fibro-odontoma, odontoma. Histopathologic diagnosis was of odontoma SOE. Twenty-year-old female leucoderm patient V.G.P. sought the dental office reporting discomfort during chewing in the left retromolar region. During the anamnesis and extraoral clinical examination, no changes were observed. In the intraoral examination during palpation, the patient reported mild discomfort in the region referred to above. The conventional periapical radiographic examination revealed a radiolucent area with well-delimited radiopaque halo circular shape in the distal region of the tooth 38 adhered in the coronary portion with radiopaque image suggestive of a tooth in formation. In view of this finding, a panoramic radiograph was requested to evaluate the area. During the surgical procedure for removal of the included tooth and the intraosseous lesion, a puncture was performed, which had a negative result. Material was sent for histopathologic examination. The diagnostic hypotheses were ameloblastic fibro-odontoma, odontoma. Histopathologic diagnosis was of odontoma SOE.

Магнитно-резонансная томография с аксиальной нагрузкой в диагностике нарушений статики поясничного отдела позвоночника

Introduction The diagnosis of spinal statics disorders requires a study conducted both with and without axial load. Standard multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) are limited to the examination of the patient in the supine position. Axial loading techniques have expanded the indications for the use of high-tech methods of radiological diagnosis in assessing the statics of the lumbar spine. Methods 124 patients underwent conventional radiographic examination of the lumbar spine in the frontal and lateral projections in a standing position and an MRI study before and during axial load. Radiography with functional tests was used for cases with displaced vertebras. The Pearson correlation coefficient was used to compare the data; the significance of the methods was evaluated using calculations of diagnostic performance indicators. Results An increase of the angle of lordosis was noted in tests with axial load (r = 0.93). Indicators of scoliotic deformity obtained with MRI with axial load corresponded to X-ray data (r = 0.89). The diagnostic efficiency of MRI with a dosed axial load was the following: Se = 91.7 %, Sp = 89.2 %, Ac = 90.6 %; the results of MRI in the upright position were slightly lower: Se = 89.2 %, Sp = 73.9 %, Ac = 83.3%. Spondylolisthesis was found in 11 patients. The instability data obtained by comparing MR studies before and during the axial load with radiography with functional tests revealed their almost complete correspondence (r = 0.88). Discussion Axial-loaded MRI can provide additional information on statics, which is necessary to assess the nature of pathological changes. MR techniques based on low-field tomographic systems are limited in the diagnosis of extended deformations. MRI with axial load is a method of choice, especially when dynamic monitoring is necessary, due to the absence of ionizing radiation. Axial loading of the spine in MSCT study seems promising.

Determining the Need for After-Hours Diagnostic Radiological Reporting in Emergency Departments at Public Hospitals in South Africa: Perceptions of Emergency Physicians in KwaZulu-Natal

BackgroundEmergency departments in South African public hospitals have a high patient load after hours, with inadequate numbers of health care professionals available to satisfy patient influx. In addition, there is often no provision of after-hours diagnostic reporting services in public hospitals, to an extent that the emergency physician is responsible for interpreting all radiographic images requested themseves.Emergency physicians, in this study, can be described as any medical doctor registered with the Health Professions Council of South Africa and working in the emergency department as a registrar or consultant physician because there were no physicians specialized in emergency medicine working at the hospitals selected for this study. AimThe aim of this study was to determine the views of emergency physicians on whether there is a need for an after-hours diagnostic radiological reporting service in selected public hospitals in KwaZulu-Natal Province, South Africa. MethodsA descriptive cross-sectional quantitative research design was utilized, through means of a survey, to assess the emergency physicians’ perceptions regarding the need for after-hours diagnostic radiological reporting. In addition, the study used a descriptive quantitative research design to record the number of conventional diagnostic radiographic examinations performed at the selected hospitals, after hours, and the proportional number of these radiographic examinations that were reported on by radiologists during office hours, the following day. The distribution of questionnaires and data collection, with regard to the number of examinations reported on, and those not reported on, were carried out simultaneously during the execution of this study. The study was conducted over a three-month period in 2017, at four public hospitals in KwaZulu-Natal—one of the nine provinces of South Africa. ResultsThis study found that, during the study period, between 0.1% and 0.6% of the conventional diagnostic radiographic examinations performed, after hours, were reported on by radiologists during office hours, the following day. The surveyed emergency physicians felt that the interpretation of diagnostic images took up valuable time that could be spent on patient management, and there was near-total agreement, whereby 92% (n = 36) of the physicians would have preferred after-hours reporting to be performed by a radiologist. Physicians agreed that having a radiologist or reporting radiographer to provide radiological reports would allow for more effective and efficient patient management. ConclusionThe results of this study indicated that there is a need for after-hours radiographic reporting at the selected public hospitals and for the further training of emergency physicians in radiographic image interpretation. Based on the findings of this study, it is recommended that after-hours radiological reporting services be considered for public hospitals and that courses be offered to emergency physicians on the interpretation of diagnostic radiographic images. A hospital policy review may therefore be needed to adjust the focus of hospitals toward reducing the workload of emergency physicians, wherever possible, such as by incorporating support services like radiographic reporting and by providing further training on the interpretation of diagnostic radiographic images, which will both act to reduce the potential risk of misdiagnosis.

Sacroiliitis Detected by Magnetic Resonance Imaging in Patients With Systemic Sclerosis.

Objectives This study aims to evaluate the magnetic resonance imaging (MRI) findings of sacroiliac joints in a selected group of patients with systemic sclerosis (SSc).Patients and methods This retrospective study included 30 patients (2 males, 28 females; mean age 44.1±12.5 years; range, 24 to 70 years) with SSc who underwent MRI of sacroiliac joints. Lesions were defined according to Assessment of SpondyloArthritis International Society (ASAS)/Outcome Measures in Rheumatology MRI group criteria. Clinical features, conventional radiograms of sacroiliac joints, presence of inflammatory back pain, human leukocyte antigen B27 (HLA-B27), and C-reactive protein (CRP) levels were extracted from patient records.Results Eleven of thirty patients (37%) revealed sacroiliitis on MRI (five with chronic, three with active sacroiliitis, and three with both active and chronic forms). On conventional radiographic examination, six patients had sacroiliitis (20%). In all of these six patients, sacroiliitis was also detected on MRI. CRP levels and number of patients with inflammatory back pain were found to be higher in the patients with active sacroiliitis (p<0.05). Seven patients were diagnosed as spondyloarthritis according to ASAS criteria.Conclusion Sacroiliitis was detected more frequently by MRI compared to conventional radiographic examination. MRI is suggested to be the preferred method for evaluating sacroiliitis in SSc patients.

Agreement Between Working Length Measurements in Primary Teeth Obtained by Radiographs or Apical Locators

Objective: To perform an in vivo evaluation on the agreement between measurements of working length obtained by conventional radiographic examinations and an apex locator in deciduous teeth with or without root resorption. Material and Methods: Nine canals of teeth from children ranging from 3 to 5 years old were selected. Endodontic access was performed with a spherical diamond tip, the pulp was removed with Kerr-type steel files, and the canal was irrigated with 1% sodium hypochlorite. A file, compatible with the channel gauge, was then used to measure the length of the root canal with the apex locator. Conventional radiographs were also performed and, using a millimeter endodontic ruler, the length of the canal was determined. The differences between the measurements obtained between the two methods were analyzed using the Student's t-test. Results: The mean canal length for conventional radiography was 9.83 mm and 9.67 mm for the apex locator. The results of this study did not show significant differences (p=0.641), independent of the presence or absence of physiological root resorption. Conclusion: The similarity in measurements obtained with X-ray or an apex locator indicates that it is not necessary to use X-rays as a complement to obtain the working length. The use of the apex locator can provide a quicker treatment, reducing the clinical time and stress of the child.