Plain Radiographs Research Articles

Swollen speech: a case study of tongue abscess detected via imaging technology

BackgroundA tongue abscess is a rare but serious condition marked by a localized accumulation of pus within the tongue’s tissues. Despite the tongue’s frequent exposure to trauma, bites, and foreign objects, it typically resists infections. However, an acute lingual abscess can be life-threatening due to the risk of airway obstruction from tongue swelling. Common symptoms include increasing pain, fever, swelling, immobility, edema, and redness of the tongue. The case report aimed to highlight the unusual clinical presentation and location of a deep-seated abscess in the anterior third of the tongue, as well as the radiographic approach to diagnosing the lesion.Case presentationA 30-year-old female patient presented with sudden onset tongue pain and swelling persisting for 4–5 days. Clinical examination revealed a solitary diffuse swelling in the anterior two-thirds of the tongue, approximately 3 × 2 cm in size. Diagnostic imaging, including a plain radiograph, ultrasound (USG), and MRI, was conducted. The patient was hospitalized for incision and drainage of the abscess, followed by a 5-day course of intravenous antibiotics.ConclusionsA tongue abscess, though rare, is a serious condition indicated by tongue swelling, pain, fever, dysphagia, and dyspnea. Diagnosis involves physical examinations and imaging studies like ultrasound or MRI. Immediate treatment includes maintaining airway patency, draining the abscess, and administering broad-spectrum antibiotics. Prompt recognition and treatment are essential to prevent severe complications such as airway obstruction and sepsis. Regular follow-up ensures complete resolution and prevents recurrence.

Updated solution for diagnosis and management of calcinosis cutis: A retrospective review.

Calcinosis cutis is classified into 5 main types: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis. However, it is occasionally misdiagnosed as a malignancy and its management remains challenging. Therefore, in this study, we report our diagnostic and treatment experiences with patients with calcinosis cutis and suggest strategies for improving patient care. This retrospective study included 7 patients (4 men, 3 women; 44.4 ± 32.0 years old) who visited our hospital between March 2013 and December 2022 and were diagnosed with calcinosis cutis through histopathological procedures. The patients underwent complete excision of the mass without a safety margin. Frozen biopsy was not performed during surgery. No significant intraoperative or postoperative complications were noted after the application of various imaging techniques for diagnosis and follow-up. All patients showed complete recovery. Follow-up showed no recurrence or complications in the 6 patients who completed 1 year of follow-up. Radiological tests such as plain radiography, ultrasonography, computed tomography, and magnetic resonance imaging are important for accurate diagnosis and treatment of calcinosis cutis. This approach can ensure precise assessment of preoperative lesions, leading to safe and less invasive patient treatment, recurrence prevention, and complications of calcinosis cutis.

Assessing Electronics with Advanced 3D X-ray Imaging Techniques, Nanoscale Tomography, and Deep Learning

This paper presents advanced workflows that combine 3D X-ray microscopy (XRM), nanoscale tomography, and deep learning (DL) to generate a detailed visualization of the interior of electronic devices and assemblies to enable the study of internal components for failure analysis (FA). Newly developed techniques, such as the integration of DL-based algorithms for 3D image reconstruction to improve scan quality through increased contrast and denoising, are also discussed in this article. In addition, a DL-based tool called DeepScout is presented. DeepScout uses 3D XRM scans in targeted regions of interest as training data for upscaling high-resolution in a low-resolution dataset, of a wider field of view, using a neural network model. Ultimately, these workflows can be run independently or complementary to other multiscale correlative microscopy evaluations, e.g., electron microscopy, and they will provide valuable insights into the inner workings of electronic packages and integrated circuits at multiple length scales, from macroscopic features on electronic devices (i.e., hundreds of mm) to microscopic details in electronic components (in the tens of nm). Understanding advanced electronic systems through X-ray imaging and machine learning—perhaps complemented with some additional correlative microscopy investigations—can speed development time, increase cost efficiency, and simplify FA and quality inspection of printed circuit boards (PCBs) and electronic devices assembled with new emerging technologies.

Unveiling the Origins of “Memory Effects” in Thick Electrodes through 2D XRF-XANES Mapping and Modeling

Making electrodes much thicker than the current commercial lithium-ion batteries is a promising approach to further increase the energy density of rechargeable batteries by reducing the weight/volume fraction of inactive components at the battery cell level. However, thick electrodes suffer inferior rate performance as non-uniform reaction develops within the electrode due to the increased ionic and electronic transport distances, which reduces the capacity utilization. In this work, we demonstrate yet another challenge faced by the application of thick electrodes (>100 µm), that is, they exhibit pronounced “memory effect” that is not seen in their thin electrode counterpart. While “memory effect” was initially observed in nickel-cadmium and nickel metal-hybrid batteries, which experience capacity reduction upon repeated shallow discharging, here we use the terminology to refer to the phenomenon that the (dis)charging performance of a lithium-ion battery depends on its cycling history. An example is illustrated in Figure 1, which shows the 2C discharge capacity of a 150μm-thick LiFePO4 electrode in a half cell when it starts from an initial state of charge (SoC) at 50%. Our experiment reveals that the discharge capacity has a strong dependence on how the electrode was first brought to the initial state. When it is charged to 50% SoC at 1.5C, the subsequent discharge capacity is 137% larger compared to when it is discharged to the same SoC at 1.5C. Similar phenomenon is also observed in another mainstream cathode NMC622. We show that such memory effect is caused by the reaction polarization present in the thick electrodes. To this end, 2D X-ray fluorescence (XRF) spectroscopy and Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS) were employed to characterize the reaction distribution within the electrodes, and its correlation to the (dis)charging kinetics and OCV relaxation were investigated by electrochemical testing and pseudo-2D battery simulation. Our study highlights the issues created by the memory effect on the capacity prediction and SoC determination, which need to be addressed to develop a better battery management system for thick-electrode-based battery cells and packs. Figure 1

Exploring Degradation in PEM Water Electrolysis Cells Due to Metal Migration: Insights from X-Ray Fluorescence Analysis

Green hydrogen production through proton exchange membrane (PEM) water electrolysis offers a viable renewable energy storage and transport solution. The Hydrogen Evolution Reaction (HER) and the Oxygen Evolution Reaction (OER) are central to this technology, with the latter’s slow kinetics posing a significant bottleneck. Despite research efforts, iridium (Ir) is the only element which currently meets the stability and activity needs of OER, challenging the search for alternatives and shifting focus towards enhancing catalyst stability [1]. Recent studies have identified metal migration, particularly of Ir, as a critical factor in the degradation of PEM water electrolyzers [2]. This finding has highlighted the importance of understanding metal migration mechanisms and the need to investigate the contribution or interaction of less studied elements such as platinum (Pt), titanium (Ti), and iron (Fe) to the degradation process.This study investigates the migration of both catalytically active (Ir, Pt) and inactive (e.g., Ti, Fe, Ca) metals within PEM water electrolysis membranes, using ex-situ 2D X-ray fluorescence (XRF) mapping (s. Fig. 1). Tests were conducted on PEM water electrolysis single cells (active area: 4 cm2) with a NafionTM 115 catalyst-coated membrane, with anode and cathode loadings of 2.0 mgIr/cm2 and 1.0 mgPt/cm2, respectively. The study entailed varying operating times (10 h, 100 h, 500 h, 1500 h) under constant load, different load profiles (e.g., open-circuit voltage (OCV) and accelerates stress test (AST) phases) for 500 h, and the introduction of specific impurities like iron (Fe) and calcium (Ca) through the anodic feed water. Complementary ICP-MS analysis of the anode and cathode waters was also performed. Selected segments of the catalyst-coated membranes (CCMs) were investigated using synchrotron radiation-based XRF at microXAS beamline (X05LA) of the Swiss Light Source (Paul Scherrer Institute, Villigen, Switzerland) at 11.0, 11.4, and 11.7 keV (below and above the Ir L3- and Pt L3-edges, for IrO2, see e.g. ref. [3]). The beam was focused using a Kirkpatrick-Baez (KB) mirror system. The spatial resolution of the measurements was approx. 1 μm, allowing selective identification and relative concentration of elements to be mapped within the entire cell cross-section (electrodes and polymer layer).Through our XRF analysis, it is possible to detect migration of the catalytically active materials (Ir, Pt) through the Nafion membrane depending on the degradation time. Interestingly, while impurity tests with Ca led to its accumulation in the membrane, Fe impurities introduced similarly did not show significant accumulation. These results, demonstrating the intricate details of metal migration and their varying behaviors under different operational conditions, underscore the value of high-resolution XRF mapping with synchrotron radiation in providing critical insights. This understanding is vital to unraveling the complex degradation mechanisms of PEM water electrolyzers. Further experiments may in principle allow for precise quantification of metal migration, with measurement of appropriate elemental standards. Figure 1. Schematic overview of the study: Catalyst-coated membranes (CCMs) at various stages of degradation are investigated using synchrotron radiation-based X-ray fluorescence (XRF) mapping. This method provides a 2D elemental distribution map, as demonstrated with Iridium (Ir) in this example. Analysis of the cross-sectional distribution of the element within the membrane allows for inferences regarding its migration. We thank the SLS for providing beam-time through an accepted proposal (20221749) and appreciate the micro-XAS beamline team’s help during measurements and data processing.

Correlative Microscopy Analysis for Battery Materials

Lithium batteries (LB) are in high demand for a diverse range of applications, such as automotive industry, consumer electronics, wearable and medical devices, grid storage, etc. Each application demands a specific set of performance advantages, such as high capacity and/or energy density, long cycle life, superior electrochemical stability. Therefore, there is no one-size-fits-all for a LB chemistry and its form factor. Battery performance advantages rely on optimization of the battery components, including active materials, electrolyte, separator, binder system, and current collectors. For meaningful device optimization, electrochemical battery testing needs to be combined with a deep understanding of the material and device microstructure. Physical and chemical characterization on the material- and electrode-level is needed to establish root-cause relationships with battery performance. Properties of the interfaces between layers of the battery components often define the device characteristics. Critical information is usually buried beneath the surface of a material specimen or encapsulated in a closed-form device. Microstructural defect identification in the battery needs to be followed by a targeted defect study. Different battery form factors and chemistries make it hard to streamline root-cause analysis.Recently, a commercial focused-ion beam scanning electron microscope was developed with an integrated fs-laser mill attached to the load lock of the microscope, opening the door to new and more powerful analysis approaches in energy materials research. Applications include rapid access to deeply buried structures for high resolution imaging and analytics, large area cross-section preparation, and massive material ablation for sample preparation of structures; e.g. FIB-SEM tomography, TEM, APT, or X-ray nanoCT. Additionally, each of these methods may be correlatively guided by prior imaging, with techniques like 3D X-ray microscopy (XRM), to enable targeted analysis and preparation. The non-destructive nature of 3D XRM makes it an ideal tool for microstructural defect identification in LB. Laser mill allows researchers to combine non-destructive X-ray defect identification with electron microscopy methods for targeted defect characterization. This approach can be used for various battery types and form factors.By combining the laser mill with 3D X-ray microscopy, this platform enables comprehensive analysis of energy materials at the nanoscale. We illustrate these concepts with application examples, and use cases demonstrating the utility of the approach.

Characterization of the Design and Performance of Commercialized Sodium-Ion Batteries

The escalating demand for energy storage solutions has spurred the commercialization of sodium-ion batteries (NIBs), prompting a paradigm shift from laboratory research to real-world applications. The success of commercial NIBs hinges on their ability to meet stringent performance metrics, ensuring competitiveness in the large-scale energy storage market. Manufacturing new cell chemistries is complex, and if the cells have design flaws and/or manufacturing defects it could hinder their performance and safety. We will present detailed findings of the NIB cell design, construction, and performance of commercialized 18650 format NIBs. The cell design and construction will be analyzed using 3D X-ray computed tomography and cell teardowns with materials analysis. In addition, the electrochemical performance of these cells will be investigated over a range of rates and temperatures. This study will provide insight into the quality and performance of some of the early to market commercialized NIBs and how it could affect their use in large scale energy storage.

Automated 3D Cobb Angle Measurement Using U-Net in CT Images of Preoperative Scoliosis Patients.

To propose a deep learning framework "SpineCurve-net" for automated measuring the 3D Cobb angles from computed tomography (CT) images of presurgical scoliosis patients.A total of 116 scoliosis patients were analyzed, divided into a training set of 89 patients (average age 32.4 ± 24.5 years) and a validation set of 27 patients (average age 17.3 ± 5.8 years). Vertebral identification and curve fitting were achieved through U-net and NURBS-net and resulted in a Non-Uniform Rational B-Spline (NURBS) curve of the spine. The 3D Cobb angles were measured in two ways: the predicted 3D Cobb angle (PRED-3D-CA), which is the maximum value in the smoothed angle map derived from the NURBS curve, and the 2D mapping Cobb angle (MAP-2D-CA), which is the maximal angle formed by the tangent vectors along the projected 2D spinal curve.The model segmented spinal masks effectively, capturing easily missed vertebral bodies. Spoke kernel filtering distinguished vertebral regions, centralizing spinal curves. The SpineCurve Network method's Cobb angle (PRED-3D-CA and MAP-2D-CA) measurements correlated strongly with the surgeons' annotated Cobb angle (ground truth, GT) based on 2D radiographs, revealing high Pearson correlation coefficients of 0.983 and 0.934, respectively.This paper proposed an automated technique for calculating the 3D Cobb angle in preoperative scoliosis patients, yielding results that are highly correlated with traditional 2D Cobb angle measurements. Given its capacity to accurately represent the three-dimensional nature of spinal deformities, this method shows potential in aiding physicians to develop more precise surgical strategies in upcoming cases.

Clinical decision making in the assessment and treatment of closed hand fractures: A scoping review.

Closed hand fractures represent a significant proportion of emergency department attendances, result in substantial health service utilisation and have a detrimental effect on quality of life. Increasingly, hand therapists in the United Kingdom provide first line fracture treatment. However, the knowledge and skills required to work in such an extended scope capacity have not been elucidated or standardised. This literature review synthesises and reports evidence for the knowledge requisite of clinicians to make evidence-based treatment decisions for patients with hand fractures. A systematic search was undertaken, using Embase, MEDLINE, PsychInfo and CINAHL electronic databases. Inclusion criteria were English language, full research reports of studies assessing of the reliability or validity of the decision-making process in hand fracture treatment published between 2013 and 2023. Data were summarised narratively. 15 studies met inclusion criteria; most assessed decision making for metacarpal fractures. Studies on imaging (n = 4) suggested the reliability of plain radiograph interpretation of hand fracture characteristics such as angulation is good and similar across various levels of experience. Agreement between surgeons and therapists in choosing surgical or nonsurgical treatment was generally good, but factors influencing decision making remained unclear. No evidence was identified that explored clinical assessment knowledge (subjective or objective patient factors) or the specific competencies required to treat hand fractures. There is limited evidence for the knowledge and skills required of clinicians for the competent assessment and treatment of hand fractures. Stakeholder consensus work is required to develop robust competencies and standardise practice.

Tendon involvement and its association with pain and hand function in patients with osteoarthritis of the hand.

To characterise the frequency and influence of tenosynovitis and tendon damage on pain and hand function using clinical examination and ultrasound (US) in hand osteoarthritis (HOA). We included 86 patients with HOA and 23 age- and sex-matched control subjects. Extensor and flexor tendons of both hands were assessed by clinical examination and US for tenosynovitis, tendon damage. Conventional radiographs were acquired. Hand function was evaluated by the function subtest of the M-SACRAH questionnaire and the Moberg pick-up test. K-means cluster analyses was calculated to assess clusters based on radiographic features and sonographic tendon scores. Ultrasound identified the involvement of ≥ 1 tendon in 60/86 (69.8%) HOA patients compared with 2/23 (8.7%) subjects (p< 0.01) in the control group. In the HOA group, US detected tendon damage more often in flexor tendons compared with extensor tendons (2.1% 0.9%, p= 0.03), while tenosynovitis was observed more often in extensor tendons compared with flexor tendons (8% vs 0.6%, p< 0001). The sensitivity and specificity of clinical examination to detect tendon involvement was 81.4% and 34.6%, respectively on the patient level and 14.5% and 83.8% on the tendon level. The cluster analyses revealed one cluster with more radiographic features of HOA and more tendon damage while more tenosynovitis was found in cluster 2. M-SACRAH function did not correlate with tendon involvement on US. This study revealed a high frequency of tendon involvement in HOA. Tendon involvement on US did not impact hand function or self-reported pain.

Microstructures and mechanical properties of friction stir welded additively manufactured Scalmalloy®

The development of high-strength advanced additively manufactured (AM) aluminum alloys is driven by the need for weight reduction in complex-shaped structural applications. In this context, heat-treatable aluminum-scandium alloy, known commercially as Scalmalloy®, offers high strength and lightness, also at high temperatures, due to solution strengthening Al3(Sc, Zr) particles. A widespread diffusion of such AM alloy is also related to welding technologies that could preserve its engineered microstructure. This study investigates the microstructural and mechanical properties of butt friction stir welding (FSW) joints of LPBF Scalmalloy® plates under different welding settings. Joint performance was evaluated under quasi-static and cyclic loading conditions. Porosity in Scalmalloy® and welds was assessed using 3D X-ray computed tomography. An aging heat treatment assessed the extent of precipitation hardening in the FSW joints. Results show that metal stirring during FSW notably reduced the intrinsic porosity of Scalmalloy®, decreasing the equivalent pore diameter from about 200 μm to 60 μm in the welded joints. Under quasi-static loading, welded specimens failed at the interface between the thermo-mechanically affected and the stir zones on the advancing side. The aging heat treatment improved the mechanical strength of Scalmalloy® from approximately 400 to 480 MPa, albeit at the expense of ductility (elongation at fracture decreased from 16 to 4%). The higher heat input and stirring developed at a low welding speed reduced lazy S defects but limited the effectiveness of subsequent aging. In fatigue testing, welded joints consistently failed within the aged base material due to the intrinsic porosity of Scalmalloy®.

Early monitoring of inlay wear after total knee arthroplasty on plain radiographs using model-based wear measurement

Wear of the ultra-high molecular-weight polyethylene (UHMWPE) component in total knee arthroplasty contributes to implant failure. It is often detected late, when patients experience pain or instability. Early monitoring could enable timely intervention, preventing implant failure and joint degeneration. This study investigates the accuracy and precision (repeatability) of model-based wear measurement (MBWM), a novel technique that can estimate inlay thickness and wear radiographically. Six inlays were milled from non-crosslinked UHMWPE and imaged via X-ray in anteroposterior view at flexion angles 0°, 30°, and 60° on a phantom knee model. MBWM measurements were compared with reference values from a coordinate measurement machine. Three inlays were subjected to accelerated wear generation and similarly evaluated. MBWM estimated inlay thickness with medial and lateral accuracies of 0.13 ± 0.09 and 0.14 ± 0.09 mm, respectively, and linear wear with an accuracy of 0.07 ± 0.06 mm. Thickness measurements revealed significant lateral differences at 0° and 30° (0.22 ± 0.08 mm vs. 0.06 ± 0.06 mm, respectively; t-test, p = 0.0002). Precision was high, with average medial and lateral differences of − 0.01 ± 0.04 mm between double experiments. MBWM using plain radiographs presents a practical and promising approach for the clinical detection of implant wear.

Single-bundle ACL combined with ALL reconstruction yields comparable outcomes in patients with varied anatomical risk factors for ACL graft failure

BackgroundAnterior cruciate ligament (ACL) graft failure is influenced by factors such as meniscal tears and tibial plateau slope. Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has reduced failure rates; however, its efficacy in high-risk patients remains unclear. This study hypothesized that combined ACL and ALL reconstruction would yield similar clinical outcomes in patients with varying risks of ACL failure.Patients and methodsA total of 76 patients who underwent primary single-bundle ACL reconstruction combined with ALL reconstruction between June 2018 and June 2021 were included. The medial tibial slope (MTS), lateral tibial slope (LTS), and anterior tibial translation (ATT) were measured using magnetic resonance imaging and plain radiography of the knee joint. The meniscal lesions were assessed during surgery. Preoperative clinical assessments and final follow-up were conducted using patient-reported outcome measurements (PROMs), including the International Knee Documentation Committee (IKDC) evaluation, Lysholm knee scoring scale, and Tegner Activity scale. PROMs were collected at least two years postoperatively.ResultsThe average follow-up was 32.5 ± 7.4 months. There were no significant differences in postoperative IKDC score, Lysholm score, or Tegner activity score between patients with or without medial meniscus injury (p = 0.155, 0.914, and 0.042, respectively), with or without lateral meniscus injury (p = 0.737, 0.569, and 0.942, respectively), medial tibial slope > 12° or ≤ 12° (p = 0.290, 0.496, and 0.988, respectively), or lateral tibial slope > 7.4° or ≤ 7.4° (p = 0.213, 0.625, and 0.922, respectively). No significant correlations were found between anterior tibial translation and postoperative IKDC (R = -0.058, p = 0.365), Lysholm (R = -0.017, p = 0.459), or Tegner activity scores (R = -0.147, p = 0.189).ConclusionOur study demonstrates that single-bundle ACL reconstruction combined with ALL reconstruction provides reliable and comparable clinical outcomes in patients with high-risk factors for ACL graft failure, such as increased tibial slope or meniscal injury. Our results suggest that the indications for ALL reconstruction may be expanded to include patients with a high tibial slope or meniscal injury, because these factors have been shown to contribute to increased rotational instability and high rates of ACL graft failure. Future prospective randomized controlled trials with large patient cohorts and long follow-up periods are needed to validate these findings and establish clear guidelines for patient selection and surgical decision-making.Level of evidenceLevel 3.

Synthetic Medical Imaging Generation with Generative Adversarial Networks for Plain Radiographs

In medical imaging, access to data is commonly limited due to patient privacy restrictions, and it can be difficult to acquire enough data in the case of rare diseases. The purpose of this investigation was to develop a reusable open-source synthetic image-generation pipeline, the GAN Image Synthesis Tool (GIST), that is easy to use as well as easy to deploy. The pipeline helps to improve and standardize AI algorithms in the digital health space by generating high quality synthetic image data that is not linked to specific patients. Its image generation capabilities include the ability to generate imaging of pathologies or injuries with low incidence rates. This improvement of digital health AI algorithms could improve diagnostic accuracy, aid in patient care, decrease medicolegal claims, and ultimately decrease the overall cost of healthcare. The pipeline builds on existing Generative Adversarial Networks (GANs) algorithms, and preprocessing and evaluation steps were included for completeness. For this work, we focused on ensuring the pipeline supports radiography, with a focus on synthetic knee and elbow X-ray images. In designing the pipeline, we evaluated the performance of current GAN architectures, studying the performance on available X-ray data. We show that the pipeline is capable of generating high-quality and clinically relevant images based on a lay person’s evaluation and the Fréchet Inception Distance (FID) metric.

Significant overlap of inflammatory and degenerative features on imaging among patients with degenerative disc disease, diffuse idiopathic skeletal hyperostosis and axial spondyloarthritis: a real-life cohort study

BackgroundDifferentiating between degenerative disc disease (DDD), diffuse idiopathic skeletal hyperostosis (DISH), and axial spondyloarthritis (axSpA) represents a diagnostic challenge in patients with low back pain (LBP). We aimed to evaluate the distribution of inflammatory and degenerative imaging features in a real-life cohort of LBP patients referred to a tertiary university rheumatology center.MethodsIn a retrospective cross-sectional analysis of patients referred for LBP, demographics, symptom information, and available imaging were collected. SpA-like changes were considered in the spine in the presence of one of the following lesions typically related to SpA: erosions, sclerosis, squaring, and syndesmophytes on conventional radiographs (CR) and bone marrow oedema (BMO), erosions, sclerosis, and fat lesions (FL) on MRI. SIJ CR were graded per New York criteria; on MRIs, SIJs were evaluated by quadrant for BMO, erosions, FL, sclerosis and ankylosis, similar to the approach used by the Berlin SIJ MRI scoring system. The final diagnosis made by the rheumatologist was the gold standard. Data were presented descriptively, by patient and by quadrant, and compared among the three diagnosis groups.ResultsAmong 136 referred patients, 71 had DDD, 38 DISH, and 27 axSpA; median age 62 years [IQR55-73], 63% males. On CR, SpA-like changes were significantly higher in axSpA in the lumbar (50%, vs. DDD 23%, DISH 22%), in DISH in the thoracic (28%, vs. DDD 8%, axSpA 12%), and in DDD in the cervical spine (67% vs. DISH 0%, axSpA 33%). On MRI, BMO was significantly higher in DISH in the thoracic (37%, vs. DDD 22%, axSpA 5%) and equally distributed in the lumbar spine (35-42%). FL were significantly more frequently identified in DISH and axSpA in the thoracic (56% and 52%) and DDD and axSpA in the lumbar spine (65% and 74%, respectively). Degenerative changes were frequent in the three groups. Sacroiliitis (NY criteria) was identified in 49% (axSpA 76%, DDD 48%, DISH 29%).ConclusionA significant overlap was found among DDD, DISH, and axSpA for inflammatory and degenerative imaging features. Particularly, SpA-like spine CR features were found in one-fourth of patients with DISH, and MRI BMO was found in one-third of those patients.

Short-term outcomes with routine use of size ≥40 femoral heads in THA: A retrospective cohort study

BackgroundUsing larger femoral heads during total hip arthroplasty (THA) may result in a more stable hip. Greater volumetric wear and frictional torque, however, may result in increased postoperative complications. The purpose of this study was to compare outcomes of patients with femoral head size ≥40 mm compared to those with femoral head size <40 mm. Materials and methodsA retrospective chart review of 504 THAs performed by a single surgeon at a single institution from 2009 to 2016 was conducted. Following exclusions, 131 THAs were identified with femoral heads ≥40 mm and 348 THAs were identified with femoral heads <40 mm. In addition to demographic data, all postoperative complications were recorded. Plain radiographs were used to rule out/in periprosthetic osteolysis and/or acetabular loosening. Chi-square tests and Student's t-tests were used to compare categorical and continuous variables, respectively. ResultsMean follow-up period for the entire cohort was 5.5 years. Complications with ≥40 mm femoral heads included 1 superficial infection and 1 deep periprosthetic joint infection (PJI). There were no cases of dislocation, osteolysis, acetabular loosening, or trunnionosis. In contrast, complications with <40 mm femoral heads included 9 dislocations and 7 PJIs. ConclusionThe routine use of large femoral heads (≥40-mm) during THA appears to be a safe option for patients at short-term clinical follow-up. Notably, 0 patients had a clinical course complicated by dislocation, osteolysis, acetabular loosening, or trunnionosis. Level of evidenceLevel III Retrospective Cohort Study.

Investigating grain-resolved evolution of lattice strains during plasticity and creep using 3DXRD and crystal plasticity modelling

Microstructure-informed crystal plasticity finite element models have shown great promise in predicting plastic and creep deformation in polycrystalline materials. These models can provide substantial insight into the design, fabrication and lifetime assessment of critical metallic components during operation, for instance, in thermal power plants. However, to correctly incorporate damage prediction into models, the microstructural strain simulated at the grain level must be accurately predicted with suitable validation. For this reason, a 3D X-ray Diffraction (3DXRD) experiment was carried out on 316H stainless steel, a material commonly used in thermal power plants, to obtain the per-grain strain response during plastic and creep deformation at 550°C. Several hundred grains within a probed X-ray volume were tracked and measured whilst loading in-situ, obtaining per-grain centre-of-mass positions, crystallographic orientations, and average lattice strain over individual grains. These data were used to calibrate a crystal plasticity model to study the plastic and creep deformation using macroscopic stress-strain and stress-relaxation data. Subsequently, the model was used to predict the average elastic strain in different grains during the cyclic creep experiment, which was validated by 3DXRD datasets. The model results reveal that {100} or {311} grain families are strongly sensitive to microstructure, thereby a polycrystal model that describes specific orientation and neighbourhood characteristics is essential to predict the local response of these grain families. Whereas, self-consistent models are suitable for {110} and {111} grain families. This study shows that only with a suitable calibration of subsurface grain behaviour, crystal plasticity models reveal grain characteristic-dependent micromechanical behaviour.

A Review of 3D Modalities Used for the Diagnosis of Scoliosis.

Spine radiographs in the standing position are the recommended standard for diagnosing idiopathic scoliosis. Though the deformity exists in 3D, its diagnosis is currently carried out with the help of 2D radiographs due to the unavailability of an efficient, low-cost 3D alternative. Computed tomography (CT) and magnetic resonance imaging (MRI) are not suitable in this case, as they are obtained in the supine position. Research on 3D modelling of scoliotic spine began with multiplanar radiographs and later moved on to biplanar radiographs and finally a single radiograph. Nonetheless, modern advances in diagnostic imaging have the potential to preserve image quality and decrease radiation exposure. They include the DIERS formetric scanner system, the EOS imaging system, and ultrasonography. This review article briefly explains the technology behind each of these methods. They are compared with the standard imaging techniques. The DIERS system and ultrasonography are radiation free but have limitations with respect to the quality of the 3D model obtained. There is a need for 3D imaging technology with less or zero radiation exposure and that can produce a quality 3D model for diseases like adolescent idiopathic scoliosis. Accurate 3D models are crucial in clinical practice for diagnosis, planning surgery, patient follow-up examinations, biomechanical applications, and computer-assisted surgery.

Long-term outcomes after capitate fractures: a median 16-year follow-up.

The long-term effects of a capitate fracture are unknown. The aim of this study was to assess both clinical and radiological long-term outcomes after a capitate fracture. From a cohort of 526 consecutive patients with post traumatic radial sided wrist pain, 23 were identified diagnosed with a capitate fracture. 16 of these (11 males and 5 females) with a median age at injury of 17.5 years (range 11-27 years) were eligible for a follow-up after a median of 16 years (range 8 to 17 years). In this study patients were examined using conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) at the time of injury and with CT at the follow-up. At follow-up radiological signs of osteoarthritis were graded in four stages and clinical outcome was evaluated by measuring range of wrist motion and grip and pinch strength. The subjective outcome was assessed using DASH and PRWE questionnaires. Five patients had isolated capitate fractures and 11 had concomitant fractures, 10 of which had a simultaneous scaphoid fracture. 14 patients had been treated non-surgically in a cast and two patients were treated surgically. None of the fractures were visible on conventional radiographs at the time of injury. At follow-up all fractures had healed without signs of avascular necrosis. In one patient, CT examination revealed osteoarthritis between the capitate and lunate. This did not cause clinical symptoms. Functional impairments and pain scores were low: median DASH score 0, median PRWE 3 and median VAS pain score 0. We found no impairment in range of motion or grip and pinch strength. At a median of 16-year follow-up, patients with a capitate fracture report normal self-assessed hand function as well as good wrist motion and strength. The risk of development of posttraumatic arthritis in the joints around the capitate is low.

Patient reported outcomes after revision ankle fixation

BackgroundFunctional outcome following ankle fracture fixation is linked to the restoration of joint congruity, anatomic alignment and stability. If surgical fixation fails to achieve these goals, revision surgery may be indicated. This retrospective study aims to report a consecutive series of fourteen patients with a minimum of one year follow up after revision ankle fixation and describe CT scan based modified Pettrone score used to assess quality of primary fixation. MethodsBetween April 2019 and August 2021, fourteen patients underwent revision ankle fracture fixation. Patients were identified by the multidisciplinary team through a review of intra-operative radiographs. Subsequently, a CT scan-based criteria which is modification of original Pettrone criteria based on plain radiographs was applied to further assess sub-optimal fixation. Demographic, clinical, radiological and patient-reported outcome measures data were collected and examined. ResultsTwelve patients exhibited protonation type injuries according to the Lauge-Hansen classification system. Syndesmotic joint was readdressed in eleven patients. The mean duration between the index surgery and the subsequent revision surgery was 46 days (inter-quartile range – 42 days). The mean Olerud-Molander Ankle Score was calculated as 58, with an IQR of 45. Similarly, the mean EQ-5D-3L VAS score was determined to be 69, with an IQR of 35. In our series, 60 % patients reported good to excellent results using OMAS. The quality-of-life scores of in these patients were also satisfactory. ConclusionWe recommend early revision fixation should be considered when primary fixation is considered inadequate in early post-operative period. The modified Pettrone criterion can be used to assess sub-optimal fixation.