Digital Radiography Research Articles

Discussion on effect of observation circumstances for image in digital radiography

The discriminability of the IQI in the film radiography is affected by the observation circumstance and the luminance of film viewer. ISO17636-2 states that the images of digital radiograph shall be examined in a dimmed room. However, it does not describe requirements for the observation environment in digital radiography, despite the fact that the environment is similar to that of a normal professional PC and the display of the images can be easily adjusted. In this report, the influence of the observation environment in digital radiography was compared as the parameters the wire diameter and the WL value of a display adjustment value when the minimum wire diameter of the image quality indicator (IQI) was percepted, using images of welded steel at t25mm and t50mm. For welded steel of t25mm, differences due to SNRN values and differences due to the observation environment of light and dark room were compared. For t50mm, differences due to the presence or absence of the observation mask for the single wire of wire IQI which is places in front of the display, differences due to the resolution and brightness of the PC monitor, and differences when the WL was adjusted arbitrarily or fixed were compared. For the Digital Radiographic testing (RT-D), the basic spatial resolutions (SRb) were obtained by measuring the profile and applying of visual observation with the duplex wire type IQI. On the other hand, when observing the image of wire type IQI, the observation ways that one was obtain the perceptible image for all wires and another was to get the perceptible single wire image by using the observation mask for watching each wire were applied. Moreover, the influence of window width (WW) and window level (WL) adjustment on the discrimination of wire-type IQI was examined by quantifying it as WW/WL. As a result, it was confirmed that the discriminality in the dimmed room and the adjustment of WW and WL were effective. In addition, using the observation a mask showed that the perception of the adjacent wire image affected observer cognition in IQI discrimination during image observation. When using viewer software profiling, SRb measurements were not affected by the observation environment, but the visual observation was affected by the environment, and when observing images in the dimmed room with RT-D, it was found that adjusting WW and WL had a greater effect on discrimination for images with low SNRN and low contrast.

Response to "Preoperative parameters (signalment, digital radiography, urinalysis, urine microbiological culture) and novel algorithm improve prediction of canine urocystolith composition".

Response to "Preoperative parameters (signalment, digital radiography, urinalysis, urine microbiological culture) and novel algorithm improve prediction of canine urocystolith composition".

Establishment of a Digital Laminography facility at the Malaysian Nuclear Agency

Digital Laminography (DL) is a technique that enables the estimation of indication depth from a set of digital projection radiographs. It allows the engineers or researchers to visualize and measure the depth from the object’s surface. The technique applies to welded components and non-metal applications such as composite materials. The technique also allows users to understand engineering problems and further analyze the cause of failures. Malaysian Nuclear Agency is pursuing the building and establishment the DL system at its facility. A gantry is designed to hold a 225kVp X-ray tube that is mechanically moved slowly. A 100 µm pixel size Digital Detector Array (DDA) is used to capture the images. This paper highlights simulation and a preliminary assessment to understand the physics and appropriate steps to build a DL system. It discusses the simulation and experimental study of exposure parameters and setup by digital radiographic testing (RT-D) of known imperfections of a welded steel plate before performing the DL measurement. The radiographic images and their achieved contrast sensitivity and image quality are analyzed according to ISO 17636-2. The results of simulations and experiments demonstrate a good and consistent ability to measure the depth and extension of the reconstructed imperfections within ± 1 mm regarding the actual size and position.

MONITORING OF A SEVERE COVID-19 PATIENT WITH PNEUMOTHORAX COMPLICATIONS THROUGH RADIOLOGICAL AND LABORATORY DIAGNOSIS

Introduction: Monitoring and treatment of severely ill patients with the coronavirus disease who are on mechanical ventilation due to the severity of the disease with the development of many complications remains a challenge. The increased incidence of pneumothorax in Covid-19 patients on mechanical ventilation may be due to a combination of infection-induced parenchymal injury and infl ammatory response with additional positive pressure ventilation. Materials and methods: In our study, we report a case of a severe Covid-19 patient with a pneumothorax complication through radiological and laboratory diagnostics. The performed radiogram of the lungs was taken each time in the AP projection in a semi-sitting position. A digital mobile X-ray device was used for imaging. All laboratory parameters that were monitored in the patient are performed in the panel of standard routine controls for patients with Covid-19. Results: The radiogram was better as the administration of therapy and chest drain were eff ective. Biochemical and hematological parameters are performed, which indicate a decrease in the number in blood count and biochemistry. The patient spent a total of 80 days in the hospital. Conclusion: Survival of a severe form of Covid-19 infection with the complication of pneumothorax is very rare, but still possible, as shown in our case. A chest radiograph with laboratory monitoring of the condition is of great importance in establishing the diagnosis of Covid-19 infection, and in the fi nal assessment of the patient's condition upon discharge from the hospital. Keywords: Covid-19, mechanical ventilation, pneumothorax, radiological diagnostics, laboratory diagnostics.

Tube voltage in chest and abdomen DR imaging: Which settings return maximal non-prewhitening model observer with eye filter (NPWE) detectability?

The non-prewhitening computational model observer with eye filter (NPWE) has been shown to reasonably predict human observer performance in general radiography and is an appropriate substitute when real clinical trials are not feasible. In this study, the NPWE model observer is used to detect specific tasks (circular designer nodules) ranging between 1 and 30mm in diameter using chest and abdomen phantom images acquired across the diagnostic energy range (60-125 kVp) with and without an anti-scatter grid. The aim of this study was to derive tube voltage (kVp) settings that return maximal NPWE detectability (d') of designer nodules, for digital radiography (DR) chest and abdomen imaging. Images of a chest phantom (LucAl phantom) and a surrogate for an abdomen (18.5cm PMMA) were acquired across the diagnostic energy range (60-125 kVp) with matched effective dose (for the respective anatomies), with and without an anti-scatter grid, on a general x-ray system. Images were captured using an Agfa DX-D 40C wireless indirect caesium iodide (CsI) imaging panel. Modulation transfer function (MTF), normalized noise power spectrum (NNPS), and contrast (C) were measured in each image and the detectability index d' was calculated for circular designer nodules with diameters ranging from 1 to 30mm (in steps of 1mm). The calculated d' peaked at a nodule diameter of 3mm irrespective of tube voltage, for both chest and abdomen images. A tube voltage of 80kVp returned maximal d' for chest imaging across all nodule diameters both with and without an anti-scatter grid. A tube voltage of 70 kVp returned maximal d' for abdomen imaging. The NPWE observer model has been used to derive tube voltages (kVp) that return maximal detectability (d') of designer nodules for chest and abdomen radiography using a modern DR imaging system. This will provide the medical physicist with a starting point in the task of optimising tube voltage range for chest and abdomen imaging.

Evaluation of clinical and radiographic warning signs for prediction of oroantral communication following tooth extractions

ObjectivesOroantral communication (OAC) is a relatively common and mild complication of maxillary tooth extractions. Preoperative prediction of OAC can reduce treatment duration and prepare both operators and patients for the procedure. This study aims to identify alarming radiographic and clinical indicators that can predict OAC therefore assisting clinical decision making to practicing general dentists.MethodsIn this retrospective case–control study the OAC group consisting of 97 cases and a control group twice the size was established. Clinical data were collected, and measurements were conducted separately by two blinded observers on digital panoramic radiographs. Inter-rater reliability was assessed. In case of disagreement a third observer’s results were utilized. The correlation between OAC and demographic data (age, sex), as well as various factors assessed on panoramic radiographs (including, but not limited to, the length of the root, root projection into the sinus, bone width, presence of mesial and distal adjacent teeth), was statistically evaluated.ResultsInter-rater reliability was found to be excellent. Several factors were identified as potential predictors of OAC. According to our model, the strongest predictors were the distance between the cemento-enamel junction and marginal bone, extent of root projection into the sinus, presence of sinus recess around the roots, angulation, and absence of the mesial adjacent tooth.ConclusionsWell-defined measurements on panoramic radiographs may aid in predicting OAC. Further prospective investigations are necessary to confirm these indicators and address factors related to clinical examination and operation.Clinical relevanceWe present several clinical and radiographic warning signs of OAC that can facilitate pre-extraction decision-making.

Impact of Aging and Knee Osteoarthritis on Lower Limb Alignment and CPAK Classification: Gender Differences in a Japanese Cohort.

Objective: This study investigates the impact of age and knee osteoarthritis (OA) on the coronal plane alignment of the lower extremity in Japanese males and females, utilizing the Coronal Plane Alignment of the Knee (CPAK) classification system. Methods: A cross-sectional analysis was conducted with 150 male and 150 female patients. Participants were divided into three groups according to age and OA progression. The mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were measured using standard digital long-leg radiographs. Arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) were calculated, and the CPAK classification was performed to verify the distribution among the three groups. Results: The results showed increased varus alignment of the mean mLDFA correlated with OA in both genders and with aging in males. The mean mMPTA did not change in males but shifted toward varus in females with both aging and OA. Both genders demonstrated a constitutional varus alignment with the progression of osteoarthritis (males: 1.3 ± 2.4° to -3.5 ± 3.7°, p < 0.001; females: -1.2 ± 3.2° to -3.6 ± 2.9°, p < 0.001). However, this trend with aging was observed only in females (0.0 ± 2.5° to -1.2 ± 3.2°, p = 0.018). JLO maintained its apex distal position with aging and OA progression in all subjects. The study further revealed a notable transition from CPAK Type II to Type I with OA progression in both genders, additionally influenced by aging in females. Conclusions: Aging affects coronal alignment and CPAK classification differently across genders. With OA progression, there was a shift toward smaller aHKA, while JLO remained unchanged. Compared to other races, young Japanese people exhibit similar CPAK distributions, but distinct differences appear in OA-affected individuals, highlighting potential racial variations in CPAK classifications.

A novel frameshift deletion variant of ARSL associated with X-linked recessive chondrodysplasia punctata 1: a case report and literature review of prenatal, confirmed cases

BackgroundX-linked recessive chondrodysplasia punctata 1 (CDPX1) is a rare congenital skeletal dysplasia characterized by stippled epiphyses, nasal hypoplasia, and brachytelephalangy. ARSL (formerly known as ARSE), a member of the sulfatase gene family located on Xp22.3, has been identified as the causative gene for CDPX1. The high clinical and genetic heterogeneity of CDPX1 presents a challenge to prenatal diagnosis.Case presentationA G1P0 woman in her 30s with an unremarkable prenatal course presented in the second trimester. Maternal diseases, tobacco, alcohol, and drug history during pregnancy were denied. Obstetrical ultrasound examination revealed a flattened nose and a flattened midface with echogenic alterations of lumbar spinous process in the fetus. Amniocentesis was performed for genetic testing. A normal karyotype and a negative result of CNV-seq were obtained. However, Whole exome sequencing (WES) in trios revealed a hemizygous ARSL variant [NM_000047.3:c.1108del p.(Trp370Glyfs*35)] in the fetus, which was maternally inherited as confirmed by Sanger sequencing. This variant was absent from the genomAD and HGMD databases. According to the ACMG guidelines, this variant was interpreted as likely pathogenic (PVS1 + PM2_Supporting). The couple decided to terminate the pregnancy. After induction of labour, a severe nasal hypoplasia was noted; and brachytelephalangy was not remarkable. Postmortem digital X-ray imaging revealed symmetrical stippled epiphyses of the vertebrae in all spine regions and enlargement of spinous process of L1-L4 vertebrae.ConclusionA novel frameshift deletion variant of ARSL and the associated fetal phenotype have been identified. This study provides useful information for prenatal diagnosis and genetic counseling of CDPX1.

Biomechanical and Physical Characteristics of Dental Dam Sheets Used for Absolute Isolation.

This study aimed to evaluate the mechanical and physical properties of dental dam sheets used for absolute isolation and to correlate the mechanical parameters with cost. Twenty-one dental dam sheets were tested: ALLPRIME; Madeitex; Sanctuary non-latex, Sanctuary latex black, green, and blue; Nic Tone blue and black; Mk Life; Elastidam; Bassi; Pribanic; Care; OK; MDCDental; Keystone; Dura Dam; Flexidam; Sanctuary blue; Nic Tone blue; Ehros; and USE. The thicknesses of the dental dam sheets were measured using a digital micrometer (Mitutoyo). The dental dam sheets (n=15) were prepared by cutting the samples with dimensions of 80 × 10 mm with a 1.7 mm hole made at the center of each specimen, following the ISO 9001 standard. The specimens were tested using a universal testing machine (Emic) at a speed of 500 mm/min until rupture to calculate rupture force (RF, N), elongation (%), and ultimate tensile strength (UTS, MPa), their thickness (mm) was measured using a digital micrometer, and scanning electron microscopy and X-ray energy dispersive spectroscopy were performed to analyze the structure and composition. The radiopacity was measured using digital radiography. Thickness, UTS, RF, and elongation data were analyzed by one-way ANOVA and Tukey's test (α=0.05). The Flexidam dental dam had the largest thickness (0.5 mm), while Nic Tone had a median thickness of 0.3 mm; the RF value (41.3 N) was higher for the thicker dental dams. The other dental dams had RF values ranging from 19 to 30 N. The highest elongation was obtained for the non-latex Sanctuary dental dam (600 mm). The Bassi dental dam had the highest UTS value (15 MPa), and medium and small particles were observed in most of the gums. A loss of continuity was detected in the structure of Sanctuary green and blue media. The predominant elements in the sheets were carbon, magnesium, sulfur, silicon, and calcium. The UTS, RF, and elongation varied substantially, indicating insufficient standardization of dental dam sheets. Nonetheless, most of the tested dental dams exhibited mechanical and physical properties suitable for clinical use. The correlation between the cost and mechanical properties of the dental dams was very low.

Artificial intelligence in traumatology.

The aim of this study was to create artificial intelligence (AI) software with the purpose of providing a second opinion to physicians to support distal radius fracture (DRF) detection, and to compare the accuracy of fracture detection of physicians with and without software support. The dataset consisted of 26,121 anonymized anterior-posterior (AP) and lateral standard view radiographs of the wrist, with and without DRF. The convolutional neural network (CNN) model was trained to detect the presence of a DRF by comparing the radiographs containing a fracture to the inconspicuous ones. A total of 11 physicians (six surgeons in training and five hand surgeons) assessed 200 pairs of randomly selected digital radiographs of the wrist (AP and lateral) for the presence of a DRF. The same images were first evaluated without, and then with, the support of the CNN model, and the diagnostic accuracy of the two methods was compared. At the time of the study, the CNN model showed an area under the receiver operating curve of 0.97. AI assistance improved the physician's sensitivity (correct fracture detection) from 80% to 87%, and the specificity (correct fracture exclusion) from 91% to 95%. The overall error rate (combined false positive and false negative) was reduced from 14% without AI to 9% with AI. The use of a CNN model as a second opinion can improve the diagnostic accuracy of DRF detection in the study setting.

Deep learning for diagnostic charting on pediatric panoramic radiographs.

Artificial intelligence (AI)-based systems are used in dentistry to ensure a more accurate and efficient diagnostic process. The objective of the present study was to evaluate the performance of a deep learning (DL) program for the detection and classification of dental structures and treatments on panoramic radiographs of pediatric patients. In total, 4821 anonymized digital panoramic radiographs of children between 5 and 13 years of age were analyzed by YOLOv4, a CNN (Convolutional Neural Networks)-based object detection model. The ability to make a correct diagnosis was tested on samples from pediatric patients examined within the scope of the study. All statistical analyses were performed using SPSS version 26.0 software. The YOLOv4 model diagnosed the primary teeth, permanent tooth germs, and brackets successfully, with high F1 scores of 0.95, 0.90, and 0.76, respectively. Although this model achieved promising results, there were certain limitations for some dental structures and treatments, including fillings, root canal treatments, and supernumerary teeth. The architecture of the present study achieved reliable results, with some specific limitations for detecting dental structures and treatments. The detection of certain dental structures and previous dental treatments on pediatric panoramic radiographs by using a DL-based approach may provide early diagnosis of some dental anomalies and help dental practitioners to find more accurate treatment options by saving time and effort.

Radiation information, protection and awareness of healthcare professionals in terms of occupational health and safety: a two–center survey study

Abstract The objective of this study was to assess the level of knowledge, protection and awareness of radiation among healthcare professionals. A total of 413 healthcare professionals from two major training and research hospitals in Istanbul took part in the study. The sample consisted of 26.6% physicians and 73.4% other healthcare professionals. There was considerable variation in the knowledge of radiation content in imaging techniques, with correct response rates of 89.3% for Computed Tomography, 80.1% for digital x-ray, and 52.8% for Magnetic Resonance Imaging. While 69.5% of respondents provided correct answers to questions regarding radiation protection principles, 64.4% demonstrated a lack of sufficient knowledge in this area. It is noteworthy that 48.4% of respondents incorrectly identified the medical imaging technique to which the public is most exposed. It was concluded that further training on radiation-related issues should be provided at the university level and through in-service training for healthcare professionals.

Radiation shielding transmission data for modern digital radiography.

Radiography is one of the most widely used x-ray imaging modalities. In National Council on Radiation Protection and Measurements (NCRP) Report No. 147, transmission data for radiographic systems were evaluated on those installed before 2000. For x-ray systems (except intraoral dental) manufactured on or after June 10, 2006, the U.S. required minimum half-value layer (HVL) was increased; for example, 2.9 (2.3) mm Al at 80kV, where the value in parenthesis denotes the earlier requirement before the above date. To calculate the transmission of the broad x-ray beam of modern digital radiography (DR) through shielding materials. X-ray beam HVLs on two DR systems (Agfa DR 600, GE Revolution XR/d) were measured in 10kV increments between 60 and 120kV, with a calibrated ionization chamber (Radcal model 10×5-60) and varying thickness of aluminum 1100 plates. Monte Carlo (Geant4) simulation was performed to calculate the transmission of broad x-ray beams through lead, concrete, gypsum, and steel, with x-ray HVLs matching those of the DR 600 at two beam filtrations (default, 1mm Al plus 0.1mm Cu added filtration). The transmission data were fitted to the Archer equation. HVLs on two DR systems with default beam filtration were consistent (median difference, 2.1%; maximum difference, 5.5%). An additional beam filtration option (1mm Al plus 0.1mm Cu) on the DR 600 substantially increased HVLs by 45.2%-61.2%. Transmission fitting parameters were provided for seven tube voltages (60-120kV) at two beam filtrations. This work presents transmission data for modern DR systems, indicating increased x-ray beam filtration compared to the primary x-ray beam in NCRP Report No. 147. The updated transmission data can enhance structural shielding evaluations at individual tube voltages or with a workload distribution.

Evaluation of fractal analysis and radiomorphometric measurements of mandibular bone structure in bruxism and non-bruxism paediatric patients.

The goal of this examination was to compare the impact of probable sleep/awake bruxism on the mandibular trabecular bone structure by fractal analysis (FA) with digital panoramic radiograph (DPR) and radiomorphometric measurements in paediatric patients with bruxism. The examination included 130 participants with 63 patients with probable sleep/awake bruxism and 67 control groups. Bilateral regions of interest (ROI) in three regions were examined as ROI1: mandibular ramus, ROI2: mandibular angulus, ROI3: anterior to the molar teeth. Radiomorphometric measurements were taken of the mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular cortical index (MCI). p < 0.05 was approved for statistical significance. The ROI-1, ROI-2, and ROI-3 values were defined to be statistically significantly high in the bruxism group (p < 0.05). No significant difference was found between the groups in the other values (p > 0.05). There was no difference in the age and gender for any of the parameters (p > 0.05). In children and adolescents, the mandibular trabecular bone can be affected by bruxism. FA can be used as an auxiliary method for finding the mandibular trabecular differences of patients with bruxism in paediatric dentistry just as it can for adults.

Impacted third molar surgery in older patients—Is patient´s age really a risk factor for complications?

ObjectivesThe aim of this study was to analyze the influence of patients´ age on perioperative complications in impacted third molar surgery and how established risk factors are affected by age.Materials and methodsThe clinical findings, digital panoramic radiographs and perioperative data of 200 patients (554 impacted third molars) that had been subjected to tooth extraction, from July 2023 until July 2024, were analyzed. Perioperative complications (Inferior alveolar nerve (IAN) hypesthesia, oroantral communication (OAC), lingual nerve (LN) hypesthesia, postoperative bleeding, postoperative infection) as well as impaction patterns and risk factors (angulation type, bone coverage, depth- and risk scores) were analyzed by age (cut-off 30 years).ResultsThe population was divided into two groups by age (Group A = ≥ 30 years (n = 52) vs. Group B = < 30 years (n = 148)). Upper third molars showed significantly deeper bone coverage, higher depth scores, higher risk scores and different angulation types in patients aged < 30 years. Mandibular third molars showed significantly deeper bone coverage, higher depth scores, higher risk scores according and different angulation types in patients aged ≥ 30 years. However, IAN hypesthesia, LN hypesthesia, postoperative bleeding and postoperative infection did not show any significant differences regarding patients’ age.ConclusionThe current findings suggest that age (cut-off 30 years) does not statistically correlate with a higher risk for postoperative complications in impacted third molar surgery in contrast to recent publications.Clinical relevanceIn contrast to recent publications, the present study falsified a positive correlation between patients’ age and the occurrence of postoperative complications in impacted third molar surgery. Therefore, other risk factors should be investigated in order to minimize these procedure specific complications.

Does the Timing of Orthognathic Surgery Affect the Level of External Root Resorption?: Surgery-First Approach Versus Conventional Orthognathic Surgery.

This study aimed to compare external root resorption levels, both linearly and areally, on panoramic radiographs in Class III patients whose treatment was completed with the conventional orthognathic surgery and the surgery-first approach. The study included 20 patients (10 female, 10 male; 23.98±2.63y) treated with conventional orthognathic surgery and 18 patients (8 female, 10 male; 27.5±3.42y) treated with surgery-first approach was included. Linear and area measurements were made on the digital panoramic radiographs taken before and at the end of the treatment of 38 patients who constituted the sample of the study. The mean changes observed in each group were evaluated using a paired t test. The chronological ages, skeletal features (type of Class III malocclusion), treatment durations, initial values, and mean changes that occurred in each group were compared using independent t test. When the changes in root lengths and root surface areas were evaluated in all teeth in both groups, a significant loss in size was measured (P<0.001). More resorption was observed in teeth 12 and 22 in the conventional surgery group (P<0.05). When the amount of resorption in both groups was compared, there was significantly more resorption in tooth number 12 in the conventional surgery group (P<0.05). The study showed that there was external root resorption in all teeth in both protocols, but the root lengths of the lateral teeth were shortened more in both groups.

Diagnostic reference levels for the city of Moscow during X-ray examinations

Diagnostic reference levels are one of the effective tools for optimizing patient radiation doses in diagnostic radiology. The staff of domestic radiology departments does not have an understanding of the development process and use of diagnostic reference levels during X-ray examinations, although this tool is a generally accepted in practice abroad. The article shows the experience of forming regional diagnostic reference levels based on measurements provided by the accredited testing laboratory of the Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department. The diagnostic reference levels for radiography in Moscow were developed for eight of the most common types of examinations based on the operation of 216 digital X-ray machines. The resulting levels, expressed in the dose-area product (cGy-cm2) and effective dose (mSv), were compared with the local diagnostic reference levels for the Ryazan region, Russia, and national diagnostic reference levels for other countries. The analysis showed continuity in the values. Some types of studies have been optimized. The developed diagnostic reference levels are the quality performance indicators foe diagnostic radiology departments and will be used to optimize a patient radiation dose during diagnostic studies in Moscow.

Automated Defect Detection through Flaw Grading in Non-Destructive Testing Digital X-ray Radiography

Automated Defect Detection through Flaw Grading in Non-Destructive Testing Digital X-ray Radiography

Clinical and pathological characteristics of gastric large cell neuroendocrine carcinoma: A report of 2 cases series and literature review.

Gastric large cell neuroendocrine carcinoma (LCNEC) is a rare, aggressive neuroendocrine carcinoma that arises from the stomach and with high malignancy. Patients with gastric LCNEC usually have a poor prognosis. The standard treatment plan has not been established and its curative effect is poor. The present study described 2 cases diagnosed with gastric LCNEC and reviewed in depth the literature to improve our understanding more about this uncommon tumor and further to provide more experience to diagnose and treat this disease. The present study reported 2 cases of gastric LCNEC in male patients aged 51 and 73 years old, respectively. Both patients had epigastric discomfort, pain, acid reflux and heartburn. The medical history was unremarkable. The ulcerative lesion located at gastric was examined in the 2 patients by taking the esophagogastroduodenoscopy (EGO), computed tomography (CT) and digital gastrointestinal radiography (GI), that both were suspected gastric malignancy. Endoscopic biopsies of the tumor led to the initial diagnosis of gastric cancer. Postoperative pathological and immunohistochemical examinations of the surgical specimens confirmed that 1 case had mixed adeno-neuroendocrine carcinoma (MANEC) and the other had LCNEC. Both patients underwent surgical resection and received etoposide-cisplatin combination chemotherapy following surgery. The operation was successful. Both patients had uneventful recoveries following surgery, and had been followed-up regularly. The general condition was satisfactory, and no tumor metastasis was observed at present.

Mandibular morphology in schizophrenia patients compared with non-psychiatric controls using digital panoramic radiography: a retrospective cross-sectional study from Istanbul, Türkiye

BackgroundSchizophrenia is a chronic severe mental disorder characterized by impairment in cognition, emotion, perception, and other aspects of behavior. In light of the association of craniofacial dysmorphology with schizophrenia, mandibular morphology may provide clues about the role of neurodevelopment in the pathophysiology of schizophrenia. This retrospective cross-sectional study aimed to compare the mandibular morphology of patients with schizophrenia with controls using digital panoramic radiography (DPR).Methods302 recorded diagnostic panoramic images obtained from 143 schizophrenia patients (98 males, 45 females), and 159 controls (73 males, 86 females), aged 18–45 years, were evaluated. Seven mandibular measurements consisting of ramus height, condylar height, gonial angle, antegonial angle, antegonial notch depth, ramal notch depth and bigonial width were measured from the DPRs in a double-blinded manner. Bivariate comparisons were carried out using the Independent t-test and Mann–Whitney U test. Logistic regression analysis was used for multivariate comparisons.ResultsLinear measurements were higher while angular measurements were lower in schizophrenia patients. Regression analyses indicated that female patients had greater ramus height (OR = 1.243; P = 0.001), condylar height (OR = 1.463; P = 0.048) and bigonial width (OR = 1.082; P < 0.001); male patients had greater ramus heights (OR = 1.216; P = 0.001) and bigonial width (OR = 1.076; P < 0.001) as well as lower antegonial angle (OR = 0.908; P = 0.012) compared to their respective controls.ConclusionQuantitative differences in mandibular morphology in schizophrenia patients versus controls deserve attention and corroborate with the concept of abnormal neurodevelopment in schizophrenia.