PACS System Research Articles

Does Gelfoam slurry embolization post-pulmonary biopsy reduce risk of pneumothorax? A prospective randomized control study

BackgroundCT-guided percutaneous transthoracic biopsy has become a widely accepted safe method in establishing the etiology of lung masses. Pneumothorax is the most commonly faced complication requiring further therapeutic intervention for treatment with chest tube drainage adding to the time of hospital stay.Aim of workWe aim to evaluate the effect of Gelfoam mixture biopsy tract embolization as a minimal added cost in reducing the overall rate of complications, the need of chest tube placement, and hospital stay.Patient and methodsA total of 138 transthoracic CT-guided lung biopsies were randomized to 70 track embolized patients and 68 control. The study protocol was approved from the National Cancer Institute ethical committee review board. Data were collected from the local PACS system and analyzed, reviewed and performed by one of three interventional radiologists. Patient records were analyzed for primary health risks, pre-procedural CT was analyzed for lesion-related risk factors, and intra-procedural CTs were analyzed for procedure-related risk factors. Outcome measures include incidence of pneumothorax, pneumothoraxes requiring chest tube insertion and hospital admission rates.ResultsMarked pneumothorax requiring chest tube insertion and hospital admission were significantly reduced in the embolized group as 7.1% compared to 19% in the non-embolized group with significant p value of 0.037. Hospital admissions reduced from 19% down to 4.3% in embolized cases with a significant p value of 0.007. On univariate regression analysis, embolization reduced chest tube placement odds by 68% (OR = 0.32, 95% CI 0.109–0.97, p = 0.044). The only significant procedural-related factor was needle pleural angle > 70° where it increased the risk of pneumothorax by 2.85 times and chest tube placement by 3.10 times. Gelfoam embolization significantly reduces the odds of post-procedural hospital admission by 81% (OR = 0.189, 95% CI 0.051–0.699, p = 0.012). In multivariate regression analysis, Gelfoam was significantly protective against chest tube insertion and prolonged hospital stay, by reducing the odds 74.3% (OR = 0.257, 95% CI 0.082–0.808, p = 0.020) and 86% (OR = 0.133, 95% CI 0.027–0.662, p = 0.014), respectively. Needle pleural angle more than 70° increased odds of chest tube insertion by 252%. Lesions that were in very low position related to the diaphragm and just behind ribs were less prone to chest tube insertion by 83% (OR = 0.164, 95% CI 0.035–0.779, p = 0.02), while those showing mediastinal invasion and central lung lesions had increased odds by 6.812 times (95% CI 1.452–31.958, p = 0.015) for longer hospital stays.ConclusionsGelfoam embolization post-CT-guided lung biopsy has proven to statistically reduce large pneumothoraces requiring chest tube insertion, longer hospital stay, and reduced unnecessary expenses.

Reflections on the Sinicization of the French Civil Mutual Aid Contract PACS System

The French PACS system has been implemented for more than 20 years to protect the rights of non-marital partners. The phenomenon of non-marital cohabitation is becoming a social reality in China. Non-marital cohabitation will lead to issues related to the identity of the parties, division of property, and child support. Therefore, in line with the main purpose of facing social reality, protecting the rights of non-marital cohabiting partners, and stabilizing social life, China should include non-marital cohabitation in the scope of family law adjustment. Because there is no relevant legislation on the protection of the rights and interests of cohabiting partners in China before this, this article starts from three perspectives: the development history of the French PACS system, the possibility of the Sinicization of the PACS system, and the significance of the Sinicized PACS system to the development of Chinese society. By discussing the similarities and differences between China and France on the conclusion procedure, property distribution, and dispute resolution in the cohabitation relationship, the proposal of the Chinese PACS system is proposed.

15. Predicting invasion of the mandible by oral squamous cell carcinoma: a systematic review

Since the introduction of the PACS system of reporting and recording scans and radiographs there are opportunities to retrospectively and prospectively to further research the usefulness of clinical examination and pre-operative imaging for the assessment of mandibular invasion by oral cancer

A Descriptive Analysis of Computed Tomography Urography (CTU) Cases in Patients With Hematuria in Comparison with Ultrasound Kub(US) And Cystoureteroscopy (CU)

The aim of our study was to correlate and evaluate the accuracy of Computed Tomography Urography (CTU) results with other imaging modalities in patients who presented with haematuria in 2020. Retrospectively comparison of CTU findings with ultrasound KUB(US) and cytoureteroscopy (CU) also have been made. This is a retrospective study in which all CTU cases in a total of 186 patients with hematuria in 2020 were included in this study. The data was retrieved from the PACS system at Department of Radiology in Hospital Sultanah Nur Zahirah Kuala Terengganu. Frequency of the clinical manifestation were calculated among the patients and compared between US, CU and CTU findings. A total of 186 patients with hematuria involved in this study. Demographic data on clinical information have exhibited microscopic hematuria, calculi, hydronephrosis and renal calculi yielded higher percentage with 81.7%, 82.8%, 72.0% and 63.4%, respectively. The correlation between hematuria and US together with CTU findings was not significant with p value of 0.259. The data also revealed 133 patients (71.5%) had similar US and CTU findings. Meanwhile, 76.0% patients who underwent CU also yielded consistent findings with CTU. This study demonstrated no significant correlation between CTU - US findings in the detection of causes of hematuria. However, there was a good correlation of US and CU with CTU in a detection causes of hematuria with almost equal accuracy and sensitivity.

Interrelations Between the Too-Long Anterior Calcaneal Process, Hind and Mid-tarsal Bone Volumes, Angles and Osteochondral Lesion of the Dome of the Talus: Analysis by Software Slicer of 69 CT Scan of Feet.

Although the association between Too-Long Anterior Calcaneal Process (TLACP) and osteochondral lesion of the dome of the talus (OCL) has been hypothesized, no study has investigated the interrelations between TLACP, hind and mid-tarsal volumes and angles and the development of OCL. The main goals of this work are: (1) to measure the volume of the calcaneum, talus, navicular and cuboid in subjects with and without TLACP; (2) to evaluate the angular relationships between talus, calcaneum and navicular in subjects with and without TLACP; (3) to assess whether TLACP has an effect on the volume of OCL. This is a retrospective study of 69 CT scans of 54 consecutive children aged 11-15years who had undergone a CT scan due to symptomatology suggestive of TLACP. The 3D Slicer software allowed to calculate the volume of the talus, calcaneum, navicular, cuboid, TLACP and OCL (in cm3). The PACS system was used to perform the angular measurements (in degrees) between talus, calcaneum and navicular in the frontal, axial and sagittal plane. Amid the 69 CT scans, 49 were found to have pathologies related to TLACP (71%, TLACP Group) and 20/69 were normal (29%, Control Group). The mean hind and mid-tarsal bone volumes of the TLACP group were comparable to those of the control group. There were 40 (81.6%) OCLs detected exclusively in pathological feet (TLACP group); 32 lesions were medial (80%), and 8 lesions were lateral (20%). According to Ferkel and Sgaglione CT Staging System, there were 22 (55%) stage 1 lesions, 5 (12.5%) stage 2A, 3 (7.5%) stage 2B and 10 (25%) stage three lesions. Only the angle between the talus and calcaneum in the frontal plane was significantly lower in pathological feet with respect to the control group (p < 0.001). In pathological feet, the talus was supinated, and the calcaneus pronated. TLACP tend to stiffen the foot, modifying its biomechanics and leading to supination of the talus and pronation of the calcaneum. This induces an overpressure at the medial side of the talus where we observed a greater frequency of medial OCL with larger volume than lateral OCL. III.

Evaluation of Epiglottic Cartilage Morphometry Using Magnetic Resonance Imaging

Aim: Epiglottic cartilage (EC) is an important larynx cartilage with elastic cartilage structure. Functionally, this structure, which acts as a gate between the larynx and the pharynx, can be damaged due to difficult intubation during the advancement of the endotracheal tube. The aim of this study; EC’s morphometric relationship with the surrounding anatomical structures is to be examined and to minimize the complications that occur in clinical applications in line with the data obtained. Materials and Methods: In the study, cervical MRI series of 79 females and 53 males aged 20 years and older were obtained from Balikesir University PACS system archive and analyzed retrospectively. The morphometric analysis of the obtained images was carried out by transferring them to the Radiant DICOM Viewer software. In the study, the distance of EC to the surrounding anatomical structures, the angle of the visceral region between the stalk of epiglottis (SE) and the thyroid cartilage (ThC), and the lengths of the fixed and free part of EC were evaluated. The data evaluated in the study were statistically analyzed using SPSS software. Results: The length values analyzed statistically in the study tended to be higher in male individuals than in female individuals. However; It was observed that the visceral region angle between SE and (ThC) tended to be higher in female individuals than in male individuals. Age and larynx length (LL), the distance of apex part of epiglottic cartilage (AEC) to root of tongue (RT), and the length of the free part of epiglottic cartilage (FEC) showed a positive correlation. The mean length of larynx was 2.45 ± 0.53 cm according to the determined reference points. Conclusion: As a result of the values reached, clinicians will be able to have an idea about the distance of AEC to RT by measuring the LL with palpation just before endotracheal intubation. Based on this, it is thought that possible EC injuries can be prevented by predicting difficult intubation.

Bone Density of the First Metatarsal Head: Which is the Best Place to Put the Screws in MIS Hallux Valgus Surgery?

Category: Basic Sciences/Biologics; Bunion Introduction/Purpose: Hallux valgus minimally invasive surgery (MIS) is becoming more common due to its good clinical and functional results. Third-generation MIS surgery uses screw fixation that is dependent on the bone density of the first metatarsal head (FMH) for optimal screw purchase. There is no information regarding areas of higher bone density (BMD) in the FMH that suggest a stronger area of fixation, nor has it been described whether it varies between different age groups or with gender. The objective of this study is to determine the BMD within four quadrants of the FMH. This finding could lead to identifying the ideal trajectory for screw placement. In addition, we evaluate BMD variation by age and gender. Methods: Transversal study. From our CT scan database, we obtained 40 patients with no previous history of first metatarsal fractures, pre existing hardware, foot surgery or osteoporosis. We divided the patients into 4 groups, each group containing 5 male and 5 female patients: group 1: &lt;30 years, group 2: 31-45 years, group 3: 46-60 years, group 4: &gt; 60 years. The main outcome is to evaluate the association between BMD in each FMH quadrant. Secondary outcomes are to identify any differences in BMD between gender and age groups. According to what has been previously discussed in the literature, two evaluators measured the Hounsfield units (HU) of each quadrant on a coronal cut located 10 mm proximal to the metatarsophalangeal joint using the Merge PACS system. Measures were averaged. Statistical analysis was performed by measuring normality with the Shapiro-Wilks test, and the ANOVA, Student's t-test, and Mann-Whitney U test. Results: The dorsolateral (DL) quadrant had the highest BMD (353.9hu) of all quadrants, followed by the lateral plantar (LP: 302.4hu), medial plantar (MP: 264.1hu), and dorsomedial (DM: 247.6hu) (p=0.001).When comparing the groups by age, DL (p=0.01) and LP (p=0.01) quadrants had significantly greater BMD in groups 1 and 2 (&lt; 45 years) than groups 3 and 4 (&gt; 45 years).When comparing BMD by gender, differences were only obtained in the group 4, in which mens had greater BMD in the DM (p=0.03), DL (p=0.02), and LP (p=0.01) quadrants.An significant inverse association between age and BMD was obtained for the DL (P=0.004) and MP (P=0.03) quadrants. Conclusion: There are differences in BMD between the quadrants of the first metatarsal head, with the greatest BMD being in the dorsolateral region at any age. BMD decreased proportionally with increasing age in the DL and MP quadrants. At the same age, there are no significant differences between gender, except in patients &gt;60 years, where women have lower BMD in almost all quadrants.

Evaluation of Distal Tibiofibular Interosseous Ligament Angle and Its Relevance in Syndesmosis Fixation

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: The interosseous ligament (IOL) of the ankle, together with the anterior and posterior inferior tibiofibular ligament (ATFL and PITFL), are important structures which stabilizes the inferior tibiofibular joint. Besides securing the fibula tightly to tibia, these ligaments prevent excessive lateral fibular displacement and external talar rotation. Thus, any injury to either bone or ligaments at this level will result in instability and abnormal joint motion. Our study aims to evaluate the anatomical angle of the ankle interosseous ligament on magnetic resonance imaging (MRI) studies to better understand the biomechanical forces that act within the distal tibiofibular joint, relevance of assimilating the anatomical angle and its relevance in syndesmosis fixations. Methods: MRIs of ankles were chosen anonymously from the global PACS system database between the months September to October 2020. A total of 34 patients' MRIs were identified. Patients who sustained bone or soft tissue injury at the level of ankle syndesmosis were excluded to avoid any ambiguity in altered position of the IOL due to trauma. The angle of interosseous ligament from the tibial plafond was measured on the coronal plane. The axial plane was used as a reference to ensure correct position of measurement. This was done in collaboration with radiologists to ensure that IOL is correctly identified, prior to start of the study. The angle was measured separately by two different investigators and the average angle was obtained for each MRI. Data was tabulated and statistical analysis was done. Results: All of the 20 ankles identified during the study period were included in the analysis. There were 10 male and 10 female patients. Nine were left ankles and 11 were right ankles. The median age was 54 years (range 14 - 83). The mean IOL angle was 65.66 degrees. The standard error of difference between the 2 investigators was 0.567 and the two-tailed P value was 0.4980. By conventional criteria, this difference is considered to be not statistically significant. Conclusion: The ligament angle formed against tibial plafond bears theoretical relevance. We propose further cadaveric studies to confirm IOL anatomical ligament angle and carrying out implant failure stress test in a lab between the implant inserted parallel to the normal angle of IOL (65 degrees) vs 90 degrees. We also propose that such studies may show that all implants to stabilize the syndesmosis may be more effective if we try to reproduce nature by replicating as close to the IOL's anatomical angle rather than using a long held dogma of fixing syndesmosis to neutralize the forces as nature intended.

A Retrospective Review of the Management of Lung Cancer Patients Referred into the Regional Neuro-Oncology Pathway in Merseyside, United Kingdom

Abstract AIMS Brain metastases (BMs) are common in lung cancer and carry adverse prognostic significance. Such occurrences should be reviewed through a regional specialist neuro-oncology MDT. Our aim is to highlight which aspects of the pathway could be contributing to delays in the treatment of lung cancer patients with BMs. METHOD All lung cancer patients discussed at the Neuro-Oncology MDT in 2020 were identified. Details of the patient journey through the pathway from diagnosis to death were obtained from the Orion System, regional PACS system, regional neuro-oncology MDT notes and electronic case notes from Clatterbridge. RESULTS Full datasets were available for 100 patients discussed at the Neuro-Oncology MDT. 49 of these were patients presenting with BMs and lung cancer synchronously. Only 5 out of 13 (38%) of synchronous patients recommended for SRS received this treatment. 7 of 13 patients received a suboptimal treatment (best supportive care or whole-brain radiotherapy). Length of time from neuro-oncology MDT discussion to receiving SRS in the synchronous cohort was 47 versus 20.3 days in the asynchronous group. A review of all 13 cases found that 4 of the 7 cases of CNS-specific deterioration were potentially preventable. Further analysis of these cases revealed common themes of lengthy delays in histological sampling (9), delayed referral or discussion in the appropriate MDT (8) and not jointly referring to neuro-oncology and respiratory oncology (7). CONCLUSION Lung cancer patients with synchronous BMs receive SRS after full staging and biopsy. There is potential evidence of suboptimal outcomes due to inflexible MDT systems and delays for histology.

Radiological Findings in SARS-CoV-2 Viral Pneumonia Compared to Other Viral Pneumonias: A Single-Centre Study.

Background Thorax computed tomography (CT) imaging is widely used as a diagnostic method in the diagnosis of coronavirus disease 2019 (COVID-19)-related pneumonia. Radiological differential diagnosis and isolation of other viral agents causing pneumonia in patients have gained importance, particularly during the pandemic. Aims We aimed to investigate whether there is a difference between CT images from patients with COVID-19-associated pneumonia compared to CT images of patients with pneumonia due to other viral agents and which finding may be more effective in diagnosis. Study Design. The study included 249 adult patients with pneumonia identified by thorax CT examination and with a positive COVID-19 RT-PCR test compared to 94 patients diagnosed with non-COVID-19 pneumonia (viral PCR positive but no bacterial or fungal agents detected in other cultures) between 2015 and 2019. CT images were retrospectively analyzed using the PACS system. CT findings were evaluated by two radiologists with 5 and 20 years of experience, in a blinded fashion, and the outcome was decided by consensus. Methods Demographic data (age, gender, and known chronic disease) and CT imaging findings (percentage of involvement, number of lesions, distribution preference, dominant pattern, ground-glass opacity distribution pattern, nodule, tree in bud sign, interstitial changes, crazy paving sign, reversed halo sign, vacuolar sign, halo sign, vascular enlargement, linear opacities, traction bronchiectasis, peribronchial wall thickness, air trapping, pleural retraction, pleural effusion, pericardial effusion, cavitation, mediastinal/hilar lymphadenopathy, dominant lesion size, consolidation, subpleural curvilinear opacities, air bronchogram, and pleural thickening) of the patients were evaluated. CT findings were also evaluated with the RSNA consensus guideline and the CORADS scoring system. Data were divided into two main groups—non-COVID-19 and COVID-19 pneumonia—and compared statistically with chi-squared tests and multiple regression analysis of independent variables. Results RSNA and CORADS classifications of CT scan images were able to successfully differentiate between positive and negative COVID-19 pneumonia patients. Statistically significant differences were found between the two patient groups in various categories including the percentage of involvement, number of lesions, distribution preference, dominant pattern, nodule, tree in bud, interstitial changes, crazy paving, reverse halo vascular enlargement, peribronchial wall thickness, air trapping, pleural retraction, pleural/pericardial effusion, cavitation, and mediastinal/hilar lymphadenopathy (p < 0.01). Multiple linear regression analysis of independent variables found a significant effect in reverse halo sign (β = 0.097, p < 0.05) and pleural effusion (β = 10.631, p < 0.05) on COVID-19 pneumonia patients. Conclusion The presence of reverse halo and absence of pleural effusion was found to be characteristic of COVID-19 pneumonia and therefore a reliable diagnostic tool to differentiate it from non-COVID-19 pneumonia.

Evaluation of radiation exposure for patients undergoing computed tomography perfusion procedure for acute ischemic stroke

Computed tomography perfusion (CTP) is contrast-enhanced dynamic imaging of the brain utilized to assess the blood flow volume and transmit time to the brain's parenchyma. Stroke is the world's second greatest cause of mortality, accounting for 11% of all deaths, and a major cause of disability. Previous studies reported a high radiation dose per procedure with an eye lens equivalent dose (mGy) ranging from 81.0 mGy to 348.0 mGy. This study's objective is to evaluate patients exposure during CTP procedures. Materials and methods. Three hundred twenty patients with ischemic stroke underwent CTP were examined at King Fahad Medical City (KFMC). The imaging protocol consists of plain CT, CT angiography (CTA), CTP, Angiography. The volume CT Dose Index (CTDIvol, mGy) and dose length product (DLP, mGy.cm) were registered from the PACS system. The effective dose calculation (E, mSv) was extrapolated using computer software. For the CTP procedure, the mean and range of DLP (mGy.cm) for the complete procedure, CT brain, CTA, CTA digital subtraction angiography (DSA), and CTP were 1045 (105–3072), 843 (277–1530), 470.5 (210–1356), 238.8 (105–439), 2712(2012–3072) examinations, respectively. The mean and range of the effective dose (mSv) and CTDIvol (mGy) were 13.2 (10.6–17.1), 80.5 (6.11–256), in that order. The patients' doses showed wide variation due to the selection of multiple phases of acquisition and exposure factors. The dose is higher than most previous studies. Radiation dose optimization is recommended by establishing diagnostic reference level (DRL), proper CT machine setting, and increasing operators' awareness regarding radiation risks.

MRA-detected intracranial atherosclerotic disease in patients with TIA and minor stroke

ObjectivesPatients with TIA and minor stroke commonly undergo CT and CTA in the emergency department with subsequent MRI with MRA for further workup. The purpose of this study was to review outpatient MRIs for TIA/stroke patients to assess the additional benefit, if any, of the MRA sequence in the detection of intracranial atherosclerotic disease in patients for whom CTA had already been performed.MethodsThe radiology reports of outpatient MRIs of the brain for TIA/minor stroke patients were retrospectively reviewed via the hospital PACS system. Following this, the imaging report from the patient’s initial presentation to the emergency department was reviewed. This index imaging and subsequent MRI were compared to assess the incidence of new vascular findings detected on the MRA sequence in patients for whom CTA had already been performed. Where new lesions had been identified at follow-up, the imaging was retroactively reviewed to assess if they were present on the index imaging.ResultsTwo hundred seven consecutive patients were reviewed. Significant (> 50%) intracranial atherosclerotic disease was present on MRA in 18 patients (8.7%). This was a new finding in 11 patients. Five had initial CTA where the atherosclerosis was not detected. All 5 of these cases were located in the posterior cerebral arteries. Incidental aneurysms were seen in 14 (6.7%); 12 were a new finding at time of MRI.ConclusionThe MRA sequence provides additional value by increasing the detection of clinically important intracranial atherosclerotic disease which may inform management in patients with minor stroke and TIA.

Evaluation of Dynamic Foraminal Stenosis with Positional MRI in Patients with C6 Radiculopathy-Mimicking Pain: A Prospective Radiologic Cohort Study.

Objective Patients with a C6 radiculopathy-mimicking complaint are always in the gray zone if the diagnosis is not clear. The aim of the study is to make the diagnosis clear if the neck and shoulder pain is caused by a dynamic stenosis of the neural foramen at the C5-C6 level. Methods Patients with a C6 radiculopathy-mimicking complaint were included in the study. Patients had a cervical spine magnetic resonance imaging (MRI) at the normal limits, or a minimal protrusion at the C5-C6 level underwent a dynamic MRI procedure. We measured the foraminal area and spinal cord diameter (SCD) at the C5-C6 level by using the PACS system ROI irregular are determination integral embedded to PACS. Inter- and intraobserver reliability of measurements was evaluated. Results were analyzed statistically, and a p value< 0.05 was accepted as statistically meaningful. Results A total of 23 patients between January 2019 and June 2019 were included in the study. There were 10 men and 13 women, and the mean age was 41.3 (range 33-53). Foraminal area decrease at C5-C6 in extension and increase in flexion when compared with the neutral position was statistically significant (p < 0.001). Foraminal area changes between the complaint side and the opposite side was not statistically different (p > 0.05). Interobserver and intraobserver reliability of measurements were classified as in almost perfect agreement. Conclusions Our present work presented dynamic and positional foraminal changes in MRI with radiculopathy-mimicking patients. Soever, we did not find a difference between the clinical complaint side and the opposite side in radiculopathy-mimicking patients. Cervical radiculopathy pain should not be attributed only to foraminal sizes. PACS embedded irregular area measurement integral allows the easy measure of a big number of patients without additional set-up and digital work requirements.

Angle of covered self-expandable metallic stents after placement is a risk factor for recurrent biliary obstruction.

BACKGROUNDStudies have shown that covered self-expandable metallic stents (CSEMS) with a low axial forces after placement can cause early recurrent biliary obstruction (RBO) due to precipitating sludge formation. AIMTo ascertain whether the angle of CSEMS after placement is a risk factor for RBO in unresectable distal malignant biliary obstruction (MBO).METHODSBetween January 2010 and March 2019, 261 consecutive patients underwent self-expandable metallic stent insertion by endoscopic retrograde cholangiopancreatography at our facility, and 87 patients were included in this study. We evaluated the risk factors for RBO, including the angle of CSEMS after placement as the primary outcome. We measured the obtuse angle of CSEMS after placement on an abdominal radiograph using the SYNAPSE PACS system. We also evaluated technical and functional success, adverse events, time to RBO (TRBO), non-RBO rate, survival time, cause of RBO, and reintervention procedure as secondary outcomes.RESULTSWe divided the patients into two cohorts based on the presence or absence of RBO. The angle of CSEMS after placement (per 1° and per 10°) was evaluated using the multivariate Cox proportional hazard analysis, which was an independent risk factor for RBO in unresectable distal MBO [hazard ratio, 0.97 and 0.71; 95% confidence interval (CI): 0.94-0.99 and 0.54-0.92; P = 0.01 and 0.01, respectively]. For early diagnosis of RBO, the cut-off value of the angle of CSEMS after placement using the receiver operating characteristic curve was 130° [sensitivity, 50.0%; specificity 85.5%; area under the curve 0.70 (95%CI: 0.57-0.84)]. TRBO in the < 130° angle group was significantly shorter than that in the ≥ 130° angle group (P < 0.01).CONCLUSIONThis study suggests that the angle of the CSEMS after placement for unresectable distal MBO is a risk factor for RBO. These novel results provide pertinent information for future stent management.

Comparison of Unilateral Knee Arthroplasty with High Tibial Osteotomy in Surgical Treatment of Medial Knee Osteoarthritis.

High tibial osteotomy (HTO) and unicondylar knee arthroplasty (UKA) are two procedures of choice in moderate medial-sided knee osteoarthritis. In this study, we aimed to compare the outcomes of patients undergoing either unilateral knee arthroplasty or open-wedge HTO both clinically and radiologically. Clinical records of 105 patients treated surgically with either medial unilateral knee arthroplasty or high tibial osteotomies were reviewed. Fifty-one cases of HTO (group 1) and 54 cases of unicompartmental knee arthroplasty (group 2) were reviewed. Radiographic follow-up data included Kellgren Lawrence index and mechanical alignment measurements using the PACS system. Clinical and functional follow-up data included range of motion degrees and functional assessment scores (Tegner, Lysholm, Knee Society Score and VAS). Mean time of follow-up was 66.10±8.14 months and 65.27±6.95 months for groups 1 and 2, respectively. The HTO group had better radiographic improvement and greater range of motion than the unicompartmental knee arthroplasty group. Despite a significant difference in Lysholm Knee Score and a slight difference in VAS score in favor of HTO, both groups were similar with regard to functional outcomes. Both techniques are satisfactory in terms of functional outcomes about five years after the operation and may be considered in cases of middle-aged medial-sided gonarthrosis (<65 years of age) who do not have additional ligament or compartmental pathology.

Reuniting Long Lost Cousins: a Novel Curriculum in Imaging Informatics for Clinical Informatics Fellows.

We developed a curriculum of imaging informatics for clinical informatics fellows. While imaging informatics and clinical informatics are related fields, they have distinct bodies of knowledge. The aim of this curriculum is to prepare clinical informatics fellows for questions regarding imaging informatics on the clinical informatics board certification examination, prepare fellows to handle issues and requests involving imaging informatics in their future roles as clinical informaticists, and develop sufficient knowledge and skills in order to interface with imaging and radiology domain experts. We mapped ACGME core competencies for clinical informatics and the clinical informatics skills and attributes to topics covered in this curriculum. Topics covered included orders vs. encounter-based workflow, understanding imaging informatics operations and the differences between an IT department leading digital image management and the radiology department, clinical decision support for radiology, procuring and integrating new modalities into a PACS system, troubleshooting slow application performance in a PACS environment, imaging sharing, artificial intelligence (AI) in imaging including AI bias, validation of models within home institution and regulatory issues, and structured reporting vs. Natural Language Processing to mine radiology report data. These topics were covered in interactive didactic sessions as well as a journal club. Future work will expand to include hands-on learning and a formal evaluation of this curriculum with current fellows and recent graduates.

A retrospective analysis of the skull base fractures: demographic characteristics, causes and imaging findings

Background and objectives: Skull base fractures have high mortality and morbidity rates and constitute a significant medical issue. The aim of the present study was to review the demographic characteristics, common locations and causes of the skull base fractures retrospectively. Methods: This retrospective study was conducted on patients who attended the Intensive Care Unit/Radiology Clinic of Adiyaman University Training and Research Hospital between 2015 and 2018 and were found to have skull base fractures. The data were accessed via PACS system of the hospital database. Age, gender, cause of the trauma, type of the skull base fracture, imaging findings and outcome of the enrolled patients were analyzed. Results: Total 138 cases who met the study criteria were enrolled in the study. The causes of the skull base fracture were as follows: fall 52.2%, traffic accident 36.2%, pounding 3.6%, firearm injury 0.7%, sharp object injury 0.7%, and other causes 6.5%. There was a statistically significant (p&lt;0.001) difference in rate of skull base fracture caused by traffic accident between the ≤18-year group and 19-45 age group. The difference between the types of epidural hematoma was not significant in all age groups (p= 0.156); however, there was a statistically significant difference for gender (female vs. male 26.1%73.9%, p=0.025). Conclusion: Skull base fractures were more common in fall from height and traffic accidents. In order to reduce skull base fractures, it is recommended to take preventive precautions for falls from height and traffic accidents. IMC J Med Sci 2022; 16(2): 002. DOI:https://doi.org/10.55010/imcjms.16.012 *Correspondence: Safiye Kafadar, Department of Radiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey. Email: safiyekafadar@gmail.com, ORCID: 0000-0003-4070-9615

Using Blumensaat's line to determine the sagittal alignment of the distal femur.

A coherent measurement approach for sagittal alignment of the distal femur after fracture reduction or distal femur osteotomies is not available. The present study aims to introduce a new method using Blumensaat'sline and tangent lines to the femoral cortexes to determine the sagittal alignment of the distal femur. 113 patients who had true lateral knee radiographs were included. All of the radiographs were evaluated by one fellowship-trained knee surgeon and one radiologist using the PACS system. The Blumensaat'sline was determined on the true lateral knee radiographs. Then, three long lines were drawn on the distal third of the femoral shaft. The first line is tangent to the anterior cortex of the femur, the second line is along with the anatomical axis of the femur, and the third line is tangent to the posterior cortex of the femur. The angles between Blumensaat'sline and these lines were measured. Intraclass Correlation Coefficient (ICC) was used to measure the strength of inter-and intra-rater agreement. The mean angle between the Blumensaat'sline and the anatomical axis of the femur was 35.4 ± 3°. The mean angle between the Blumensaat'sline and the line tangent to the anterior femoral cortex and the line tangent to the posterior femoral cortex were 34.5 ± 3° and 35.2 ± 3°, respectively. Excellent inter-and intra-rater reliabilities were observed between the measurements (ICC = 0.96 and ICC = 0.98, respectively). The angle between the Blumensaat'sline and the line tangent to the posterior femoral cortex was significantly higher in participants aged < 38years (p = 0.049). No other significant association was found between the angles and demographic characteristics of the patients. The expected mean angles between the Blumensaat'sline and the distal femur were 34.3 to 35.4 degrees. This finding could be useful to determine the normal sagittal alignment of the distal femur. II.

Abstract 14: Receiver Operating Characteristics Curve Analysis Demonstrates That Quantitative Assessment Of Iodine Contrast Extravasation Post Reperfusion Therapy For Ischemic Stroke Predicts Reperfusion Injury And Discharge Modified Rankin

Introduction: We previously demonstrated that the quantitative volumetric assessment of iodinated contrast extravasation (ICE) present on post-intervention imaging was closely associated with the likelihood of an acute ischemic stroke patient having PH-1 or PH-2, and thus ICE may serve as a useful CT biomarker to assess risk of reperfusion injury (hemorrhagic conversion (HC) and blood brain barrier (BBB) disruption). Here we used receiver operator curve (ROC) analysis to compare the efficacy of ICE, infarct volume, and 24hr NIHSS change as a predictor of discharge mRS and HC post-reperfusion therapy. Method: Data on ischemic stroke patients treated with reperfusion therapy were obtained from our Institutional Review Board approved database from January 2017 to November 2019 that had evaluable images within 24 hours of admission. Ischemic volume (IV) was measured on diffusion-weighted imaging. ICE was measured on CT head. A freehand 3D region of interest tool on the Visage Imaging PACS System was used to measure volumes. Susceptibility weighted MRI sequences were used to grade HC. Data analysis was conducted with regression modeling and ROC analysis. Results: Of the 82 patients, median age was 73 (interquartile range (IQR) 61- 77, 49% were women, admission NIHSS was 12 (IQR 7 - 21), 24hr NIHSS change was 4 (IQR 0 -13), IV was 50.6 +/- 7.1 mL, 48% were treated with thrombectomy, 7% had PH-1 or PH-2 identified on MRI, median systolic blood pressure was 154 (IQR 137-175), 56% were MCA territory strokes, and 37% had a discharge mRS of 0-2. ICE volume was 2.6 +/- 1.0 mL. ICE increased the likelihood of PH-1 or PH-2 HC (odds ratio (OR) 14.34, 95% confidence interval (CI) 5.74 - 22.94) and decreased the likelihood of discharge with mRS of 0-2, OR of 0.09 (CI 0.008-0.972). IV was a better predictor of 0-2 mRS (ROC area under the curve (AUC) 0.832) than ICE (AUC 0.640) and 24hr NIHSS change (AUC 0.557), but ICE was a better predictor of PH-1 or PH-2 (AUC 0.942) than IV (AUC 0.667) and 24hr NIHSS change (AUC 0.447). Conclusion: ICE may predict reperfusion injury and functional outcome, but it is a better predictor of hemorrhagic conversion in patients treated with reperfusion therapy.

Single Center Evaluation of Comparative Breast Radiation dose of Contrast Enhanced Digital Mammography (CEDM), Digital Mammography (DM) and Digital Breast Tomosynthesis (DBT)

The aim of this retrospective study is to compare the radiation dose received during CEDM, short and long protocol (CEDM SP and CEDM LP), with dose received during DM and DBT on patients with varying breast thickness, age and density. Between January 2019 and December 2019, patients having 6214 DM, 3662 DBT and 173 CEDM examinations in our department were analyzed. Protocol total single breast AGD has been evaluated for all clinical imaging protocols, extracting AGD values and exposure data from the dose DICOM Structured Report (SR) information stored in the hospital PACS system. Protocol AGD was calculated as the sum of single projection AGDs carried out in every exam for each clinical protocol. A total amount of 23,383 exams for each breast were analyzed. Protocol AGDs, stratified as a function of patient breast compression thickness, age, and breast density were assessed. The total protocol AGD median values for each protocol are: 2.8 mGy for DM, 3.2 mGy for DBT, 6.0 mGy for DM+DBT, 4.5 mGy for CEDM SP, 7.4 mGy for CEDM SP_DBT (CEDM SP protocol with DBT), 8.4 mGy for CEDM LP and 11.6 mGy for CEDM LP_DBT (CEDM LP protocol with DBT). CEDM SP AGD median value is 59% higher than DM AGD median value and 40% lesser than DM+DBT AGD median; this last difference was statistically confirmed with a p-value <0.001. AGD value for each standard breast CEDM SP projection results to be below 3-mGy limit. AGD value for each standard breast CEDM SP projection results to be below 3 mGy, as required by international legislation. For dense breasts, the AGD median value is 4.2 mGy, with the first and third quartile of 3.3 mGy and 6.0 mGy respectively; for non-dense breasts, the AGD median value is 4.7 mGy, with first and third quartile of 3.5 mGy and 6.3 mGy respectively. The difference between the two groups was statistically tested and confirmed, with a p-value of 0.039. CEDM SP results in higher radiation exposure compared with conventional DM and DBT but lower than the Combo mode. The dose administered during the CEDM SP is lower in patients with dense breasts regardless of their size. An interesting outcome, considering the ongoing studies on CEDM screening in patients with dense breasts.