Radiation Exposure Costs Research Articles

Gait Analysis to Monitor Fracture Healing of the Lower Leg

Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier methods to monitor the healing process are required. In this review, we provide an overview of the changes in gait parameters following lower leg fractures to investigate whether gait analysis can be used to monitor fracture healing. Studies assessing gait after lower leg fractures that were treated either surgically or conservatively were included. Spatiotemporal gait parameters, kinematics, kinetics, and pedography showed improvements in the gait pattern throughout the healing process of lower leg fractures. Especially gait speed and asymmetry measures have a high potential to monitor fracture healing. Pedographic measurements showed differences in gait between patients with and without union. No literature was available for other gait measures, but it is expected that further parameters reflect progress in bone healing. In conclusion, gait analysis seems to be a valuable tool for monitoring the healing process and predicting the occurrence of non-union of lower leg fractures.

C-arm positioning for standard projections during spinal implant placement.

Fluoroscopy-guided trauma and orthopedic surgeries involve the repeated acquisition of correct anatomy-specific standard projections for guidance, monitoring, and evaluating the surgical result. C-arm positioning is usually performed by hand, involving repeated or even continuous fluoroscopy at a cost of radiation exposure and time. We propose to automate this procedure and estimate the pose update for C-arm repositioning directly from a first X-ray without the need for a patient-specific computed tomography scan (CT) or additional technical equipment. Our method is trained on digitally reconstructed radiographs (DRRs) which uniquely provide ground truth labels for an arbitrary number of training examples. The simulated images are complemented with automatically generated segmentations, landmarks, and with simulated k-wires and screws. To successfully achieve a transfer from simulated to real X-rays, and also to increase the interpretability of results, the pipeline was designed to closely reflect the actual clinical decision-making process followed by spinal neurosurgeons. It explicitly incorporates steps such as region-of-interest (ROI) localization, detection of relevant and view-independent landmarks, and subsequent pose regression. The method was validated on a large human cadaver study simulating a real clinical scenario, including k-wires and screws. The proposed procedure obtained superior C-arm positioning accuracy of dθ=8.8°±4.2° average improvement (pt-test≪0.01), robustness, and generalization capabilities compared to the state-of-the-art direct pose regression framework.

Importance of radiographs in edentulous patients

Panoramic radiographs are often used to screen edentulous patients before complete denture fabrication. However routine use of OPG (Orthopantomogram) of edentulous patients is being questioned because of the cumulative effects and cost of radiation exposure. However, the recent studies have shown that the pre-treatment radiographic examination of edentulous patients is critical in the treatment planning, as it has revealed significant findings, which are not visible clinically. Keywords: Edentulous, Orthopantomogram, Impacted, Teeth

Whole-Body CT after Motor Vehicle Crash: No Benefit after High-Energy Impact and with Normal Physical Examination

Performing a whole body computerized tomography (CT) scan after a motor vehicle crash (MVC) when the physical exam suggests no new injury remains a source of debate. It remains a common practice despite prospective evidence of no reduction in mortality. Prior retrospective studies have shown a potential mortality benefit of whole-body CT following these traumas compared to selective scanning, but the overall quality of evidence is lacking. Proponents argue that whole-body CT finds more injuries and injuries that may have been missed on exam, but it comes with the cost of radiation exposure, possible adverse effects of iodine contrast, and added expense. The Vittel criteria, originally used for field triage, now guide whole-body CT decisions in France. The Vittel criteria include physiologic variables, kinetic components or mechanism of injury, injuries sustained, and resuscitation required. Use of these criteria as an indication to perform whole-body CT has lacked specificity. Investigators in this retrospective study hypothesized that patients involved in an MVC with a GCS of 15, a normal exam of the torso, and only a kinetic component of the Vittel criteria, whole-body CT is not indicated.

Utility of multiple rule out CT screening of high-risk atraumatic patients in an emergency department-a feasibility study.

Several large trials have evaluated the effect of CT screening based on specific symptoms, with varying outcomes. Screening of patients with CT based on their prognosis alone has not been examined before. For moderate-to-high risk patients presenting in the emergency department (ED), the potential gain from a CT scan might outweigh the risk of radiation exposure. We hypothesized that an accelerated "multiple rule out" CT screening of moderate-to-high risk patients will detect many clinically unrecognized diagnoses that affect change in treatment. Patients ≥ 40years, triaged as high-risk or moderate-to-high risk according to vital signs, were eligible for inclusion. Patients were scanned with a combined ECG-gated and dual energy CT scan of cerebrum, thorax, and abdomen. The impact of the CT scan on patient diagnosis and treatment was examined prospectively by an expert panel. A total of 100 patients were included in the study, (53% female, mean age 73years [age range, 43-93]). The scan lead to change in treatment or additional examinations in 37 (37%) patients, of which 24 (24%) were diagnostically significant, change in acute treatment in 11 (11%) cases and previously unrecognized malignant tumors in 10 (10%) cases. The mean size specific radiation dose was 15.9mSv (± 3.1mSv). Screening with a multi-rule out CT scan of high-risk patients in an ED is feasible and result in discovery of clinically unrecognized diagnoses and malignant tumors, but at the cost of radiation exposure and downstream examinations. The clinical impact of these findings should be evaluated in a larger randomized cohort.

Protez Yapımı Öncesi Radyografik Değerlendirmenin Önemi: İki Olgu Sunumu

The use of X-rays is an integral part of clinical dentistry and radiographs are often referred to as the clinician’s main diagnostic aid. Radiographs should be taken only when a clear diagnostic need exists for the information the radiograph may provide. They often are the first method used to screen edentulous or partially edentulous patients before denture therapy. However, routine radiographic examination of these patients is being questioned because of the cumulative effects and cost of radiation exposure. This report presents two cases that were not examined radiologically prior to denture construction In present cases, although one patient has worn complete denture and the other has had bridges, 19 impacted teeth were observed totally in panoramic examinations. In conclusion, even a patient had worn denture or bridges; radiographic examination should be made before renew prostheses when patient did not give a definitive history about his/her radiological condition

C-arm Positioning Using Virtual Fluoroscopy for Image-Guided Surgery.

Fluoroscopically guided procedures often involve repeated acquisitions for C-arm positioning at the cost of radiation exposure and time in the operating room. A virtual fluoroscopy system is reported with the potential of reducing dose and time spent in C-arm positioning, utilizing three key advances: robust 3D-2D registration to a preoperative CT; real-time forward projection on GPU; and a motorized mobile C-arm with encoder feedback on C-arm orientation. Geometric calibration of the C-arm was performed offline in two rotational directions (orbit α, orbit β). Patient registration was performed using image-based 3D-2D registration with an initially acquired radiograph of the patient. This approach for patient registration eliminated the requirement for external tracking devices inside the operating room, allowing virtual fluoroscopy using commonly available systems in fluoroscopically guided procedures within standard surgical workflow. Geometric accuracy was evaluated in terms of projection distance error (PDE) in anatomical fiducials. A pilot study was conducted to evaluate the utility of virtual fluoroscopy to aid C-arm positioning in image guided surgery, assessing potential improvements in time, dose, and agreement between the virtual and desired view. The overall geometric accuracy of DRRs in comparison to the actual radiographs at various C-arm positions was PDE (mean ± std) = 1.6 ± 1.1 mm. The conventional approach required on average 8.0 ± 4.5 radiographs spent "fluoro hunting" to obtain the desired view. Positioning accuracy improved from 2.6° ± 2.3° (in α) and 4.1° ± 5.1° (in β) in the conventional approach to 1.5° ± 1.3° and 1.8° ± 1.7°, respectively, with the virtual fluoroscopy approach. Virtual fluoroscopy could improve accuracy of C-arm positioning and save time and radiation dose in the operating room. Such a system could be valuable to training of fluoroscopy technicians as well as intraoperative use in fluoroscopically guided procedures.

Kidney stone imaging with 3D ultra-short echo time (UTE) magnetic resonance imaging. A phantom study.

Computed tomography (CT) is the current gold standard for imaging kidney stones, albeit at the cost of radiation exposure. Conventional magnetic resonance imaging (MRI) sequences are insensitive to detecting the stones because of their appearance as a signal void. With the development of 2D ultra-short echo-time (UTE) MRI sequences, it becomes possible to image kidney stones in vitro. In this work, we optimize and implement a modified 3D UTE MRI sequence for imaging kidney stones embedded in agarose phantoms mimicking the kidney tissue and in urine phantoms at 3.0T. The proposed technique is capable of imaging the stones with high spatial resolution in a short scan time.

ASSESSMENT OF POPULATION AND TERRITORY REHABILITATION EFFICIENCY REGARDING RADIATION EXPOSURE

The suggested assessment of rehabilitation measure efficiency is distinguished by the fact that integral risk interpretation is considered, which takes total radiation exposure and reduction of life standards caused by it into account. A rehabilitation measure structure in the context of radiation emergency is given. Classification of direct and mediated consequences of an emergency is given. Optimization of rehabilitation measures is carried out from the position of quality and security of life balancing. Corresponding expenses are compared to the cost of radiation exposure and its social equivalent damage. The role of an efficiency criterion is given to an integral damage minimum.

Rupture Hardware Minimization in Pressurized Water Reactor Piping

Abstract For much of the high-energy piping in light water reactor systems, fracture mechanics calculations can be used to assure pipe failure resistance, thus allowing the elimination of excessive rupture restraint hardware both inside and outside containment. These calculations use the concept of leak-before-break (LBB) and include part-through-wall flaw fatigue crack propagation, through-wall flaw detectable leakage, and through-wall flaw stability analyses. Performing these analyses not only reduces initial construction, future maintenance, and radiation exposure costs, but also improves the overall safety and integrity of the plant since much more is known about the piping and its capabilities than would be the case had the analyses not been performed. This paper presents the LBB methodology applied at Beaver Valley Power Station—Unit 2 (BVPS-2); the application for two specific lines, one inside containment (stainless steel) and the other outside containment (ferritic steel), is shown in a generic sense using a simple parametric matrix. The overall results for BVPS-2 indicate that pipe rupture hardware is not necessary for stainless steel lines inside containment greater than or equal to 6-in. (152-mm) nominal pipe size that have passed a screening criteria designed to eliminate potential problem systems (such as the feedwater system). Similarly, some ferritic steel line as small as 3-in. (76-mm) diameter (outside containment) can qualify for pipe rupture hardware elimination.

Leak-before-break: An integrated approach for high energy piping

An integrated approach that involves system design, thermal hydraulics, materials, and fracture mechanics analyses to assure that pipe failure is highly unlikely is described. This approach is based on a leak-before-break (LBB) premise and includes through-wall flaw detectable leakage, through-wall flaw stability, and part-through-wall flaw fatigue crack propagation calculations. A successful application of LBB can reduce the amount of excessive pipe rupture restraint hardware. Assuring LBB not only reduces initial construction, future maintenance, and radiation exposure costs, but the overall safety and integrity of the plant are improved. This last benefit comes about from gaining additional insight into the piping systems and their capabilities. Details of the LBB methodology are presented here with specific examples for two pressurized water reactor lines (one inside containment fabricated of stainless steel, and the other outside containment made from ferritic steel). The application of this approach at Beaver Valley Power Station—Unit 2 indicates that pipe rupture hardware is not necessary for stainless steel lines inside containment as small as 6-in (152 mm) nominal pipe size that have passed screening criteria designed to eliminate potential problem systems (such as the feedwater system). Similarly, some ferritic steel lines as small as 3-in (76 mm) diameter (outside containment) can qualify for pipe rupture hardware elimination.