Plain Radiographs In Patients Research Articles

Significant systematic bias of alpha angles measured on MRI compared to various radiographic views in patients with femoroacetabular impingement syndrome.

The aim of this study was to assess the inter-rater reproducibility and inter-method comparability of hip alpha angle measurements on magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA) and plain radiographs in patients with femoroacetabular impingement syndrome (FAIS). A cross-sectional study of patients who were diagnosed with symptomatic FAIS underwent preoperative MRI/MRA with axial oblique and/or radial plane imagingand had preoperative radiographs with anterior-posterior (AP), 45° Dunnand 90° Dunn views. Alpha angle measurements were performed independently by two musculoskeletal radiologists. Inter-rater reproducibility and inter-method comparability between MRI/MRA images and radiographic views were assessed using the intraclass correlation coefficient (ICC) with 95% confidence interval (CI). Ninety-seven patients were included of whom 93 (95.8%) received axial oblique plane images and 54 (55.6%) had radial plane MRI/MRA images. Inter-rater reproducibility was excellent (ICC > 0.9) for all planes on MRI/MRA and radiographs. MRI/MRA axial oblique images had poor (ICC 0.39, 95% CI [0.09, 0.59]), moderate (ICC 0.57, 95% CI [0.18, 0.75])and moderate (ICC 0.64, 95% CI [0.20, 0.81]) comparability with AP, 45° Dunnand 90° Dunn, respectively. MRI/MRA radial plane images had equivocal (0 included in all CIs) comparability with AP (ICC 0.66), 45° Dunn (ICC 0.35)and 90° Dunn (ICC 0.14) radiographs. On average, alpha angle measurements were significantly higher with radial images and lower with axial oblique images, when compared to all radiographic views (p < 0.05), except axial oblique versus 45° Dunn views, where angles measured on axial oblique were significantly larger. Alpha angle measurements taken on axial oblique MRI/MRA images show moderate comparability to radiographic 45° Dunnand 90° Dunn views despite negative bias to measurements taken on radiographic AP and 45° Dunn view. Larger alpha angles were appreciated on MRI/MRA radial and axial oblique views compared to radiographic views supporting the inclusion of MRI/MRA alpha angle measurements to properly identify deformity. Level II.

A technical tip for assessing leg length discrepancy in radiographs with windswept hips

Restoration of equal leg lengths is essential when performing total hip arthroplasty. Pre-operatively, surgeons should assess leg length discrepancy (LLD) on plain radiographs to help adequately plan their operation. Often the hips are in a minor windswept position on radiographs and this can make assessing LLD unreliable. We have devised a simple method for assessing LLD on plain radiographs in patients with windswept hips.

THE PREDICTIVE VALUE OF VASCULAR CALCIFICATION ON PLAIN RADIOGRAPHS OF THE FOOT TO DIAGNOSE DIABETES MELLITUS

IntroductionThere are nearly 500,000 people with undiagnosed diabetes mellitus in the UK. The incidental finding vascular calcification on plain radiographs in patients with undiagnosed diabetes has the potential to alter patient management in those presenting with pathology. We hypothesised that the presence of vascular calcification on plain radiographs of the foot may predict the diagnosis of diabetes. The primary aim of this case control study was to determine the positive predictive value of vascular calcification to diagnose diabetes. Secondary aims were to determine the odds of having diabetes dependent on other known risk factors for calcification.MethodsA retrospective case control study of 130 diabetic patients were compared to 130 non-diabetic patients that were matched for age and gender. The presence of vascular calcification in anterior, posterior or plantar vessels, and length of calcification were measured on plain radiographs. McNemar's Chi-squared test and positive predictive values were calculated. Conditional logistic regression models were used to estimate the association between calcification and diabetes.Results28 patients had type I diabetes and 102 had type II diabetes. The mean age was 58.0 in both groups and 31.5% were females. 89.2% of those with diabetes had calcification present, and 23.1% in those without (p &lt; 0.0001). Calcification in two vessels predicts diabetes with a positive predictive value of 91.2% (95% CI 82.1%–100%). The odds ratio for having diabetes is 78 (95% CI: 7.8 – 784) times higher in a person who has calcification in the blood vessels of their foot than in a person without calcification after adjusting for confounders.ConclusionThis study has demonstrated that vascular calcification in 2 vessels is over 90% predictive of a diagnosis of diabetes. This screening test could be used in future clinics when interpreting radiographs, aiding in the diagnosis of diabetes and altering patient management.

Comparison of Ultrasonographic Findings with Plain Radiography in Patients with Knee Osteoarthritis

Background Knee osteoarthritis is one of the most commonly encountered joint disease with prevalence ranging upto 7.9%. There are various radiologic instruments to measure the disease severity of knee osteoarthritis. Kellgren Lawrence (KL grading) classification is commonly used radiographic tool to assess severity. High frequency musculoskeletal ultrasound is being used now-a-days as a reliable tool for assessment of osteoarthritis Objective To compare musculoskeletal findings with X-ray findings in knee osteoarthritis Method A prospective crosssectional study was conducted in patients with knee osteoarthritis in national centre for rheumatologic disease. An AP view standing X-ray was done for the involved knee and K-L grading was done. High frequency musculoskeletal ultrasound was done for the same knee. Synovial hypertrophy, Doppler activity, cartilage thickness (medial, lateral, intercondylar), osteophytes were noted. Pearson’s coefficient of correlation was calculated to compare the correlation between musculoskeletal ultrasound and radiographic findings Result A total of 138 patients with knee osteoarthritis were enrolled in the study with female predominance of 83% and mean age of 56.87± 10.61 years. A negative correlation was observed between cartilage thickness (medial) with joint space narrowing (KL grading) Conclusion Musculoskeletal ultrasound may be used in clinical practice to diagnose and monitor cases of knee osteoarthritis. It is potential imaging technique which might help in therapeutic interventions as well as disease monitoring.

The predictive value of vascular calcification on plain radiographs of the ankle to diagnose diabetes mellitus

IntroductionThere are nearly 500,000 people with undiagnosed diabetes mellitus in the UK. A common complication of diabetes is vascular calcification. The incidental finding of vascular calcification on plain radiographs in patients with undiagnosed diabetes has the potential to alter patient management. We hypothesised that the presence of vascular calcification on plain radiographs of the foot may predict the diagnosis of diabetes and aimed to determine the positive predictive value of vascular calcification to diagnose diabetes. MethodsA retrospective case control study compared 130 diabetic patients to 130 non-diabetic patients that were matched for age and gender. The presence of vascular calcification in anterior, posterior or plantar vessels was measured on plain radiographs. McNemar’s Chi-squared test and positive predictive values were calculated. Conditional logistic regression models estimated the association between calcification and diabetes ResultsThe overall mean age was 58.0 % and 31.5 % were females. 89.2 % of those with diabetes had calcification present, and 23.1 % in those who did not have diabetes had calcification. McNemar’s test for independence gives p < 0.001.Calcification in both anterior and posterior vessels predicts diabetes with a positive predictive value of 91.2 % (95 % CI 76.9–97.0 %).The odds ratio for having diabetes is 78 (95 % CI: 7.8 – 784) times higher in a person who has calcification in the blood vessels of their ankle than in a person without calcification after adjusting for confounders ConclusionThis study has demonstrated that vascular calcification in the anterior and posterior blood vessels is over 90 % predictive of a diagnosis of diabetes. This screening test could be used in future clinics when interpreting radiographs, aiding in the diagnosis of diabetes and altering patient management.

The effect of disease-modifying antirheumatic drugs (DMARDs) on bone homeostasis in rheumatoid arthritis (RA) patients.

The autoimmune disease known as rheumatoid arthritis (RA) has been linked to the deterioration of bone. Bone erosion is a hallmark of RA and is linked to the severity of the disease as well as a poor functional result. Erosion of periarticular cortical bone is a common feature seen on plain radiographs of patients with RA. This characteristic feature is the result of excessive bone resorption and inadequate formation of bone. It has been determined that there is a complex interaction between the inflammatory condition seen in RA and bone destruction. Increased knowledge of the pathways and other mechanisms involved in osteoclastogenesis has resulted from advances in both animal and clinical investigations. Also, Biological and targeted medicines have modified RA's bone metabolism. Here, we provide a narrative overview of the literature on the pathomechanisms of bone structure involved in biological and targeted treatments for RA and also, the clinical implications of disease-modifying antirheumatic drugs (DMARDs) are discussed. In light of the fact that these newer treatments present patients with RA with new possibilities for disease improvement and symptom control, it is imperative that additional rigorous evidence be gathered to provide a clinical reference for both patients and their treating physicians.

Point Prevalence and Associated Factors of Hip Displacement in Pediatric Patients With Mitochondrial Disease.

Objective: Mitochondrial disease is a multisystem disorder resulting from mitochondrial dysfunction. Although musculoskeletal system is vulnerable to mitochondrial dysfunction, little information is available on orthopedic issues such as hip displacement and scoliosis in patients with mitochondrial disease. We aimed to examine the point prevalence of hip displacement and investigate the associated factors in patients with mitochondrial disease.Methods: We retrospectively reviewed the medical records and plain radiographs of patients diagnosed with mitochondrial disease between January 2006 and January 2019 at a single institution. Data, including patient age, sex, follow-up duration, syndromic diagnosis, and gross motor function were collected. Migration percentage was measured on the radiographs. The clinical and radiologic variables were compared between patients classified according to the presence of hip displacement and motor function level.Results: We included 225 patients (135 men, 90 women). The mean age at the latest follow-up was 11.1 years, and the mean follow-up duration was 7.0 years. Hip displacement was noted in 70 (31.1%) patients. The proportion of patients with Leigh disease (p = 0.007) and the ratio of non-ambulators (p < 0.001) were higher among patients with hip displacement. The proportion of patients with Leigh disease was higher in the non-ambulators than the ambulators.Conclusion: One-third of patients with mitochondrial disease developed hip displacement. Hip displacement was more common in non-ambulators or patients with hypertonia. Careful and serial monitoring for hip problems is required for non-ambulatory patients with mitochondrial disease who have increased muscle tone.

Assessment of Usefulness of CT Scan in AO Classification of Intertrochanteric Fractures: A Prospective Observational Study.

The sliding hip screw (SHS) is the gold standard for the management of stable intertrochanteric (IT) fractures. However, intramedullary implants are now being increasingly used for management of unstable IT fractures especially those with a compromised or vulnerable lateral wall. Therefore, accurate classification of fracture is important to ensure proper surgical planning and choice of implant. The AO classification for IT fractures is based on plain radiographs alone and many authors have reported it to have poor inter- and intra-observer agreement. Therefore, the objectives of the study were to assess the improvement in inter- and intra-observer agreement of the AO classification after addition of CT scan to plain radiographs, to assess the change in pattern of AO classification on addition of CT scan to plain radiographs and to assess percentage of times, stable lateral wall seen on plain radiographs is classified as unstable or broken on CT scans. Fifty-four patients of intertrochanteric fracture were included in study. Plain radiographs of patients were shown to three orthopedic surgeons. They were asked to document the AO classification of the fracture, and comment on the integrity of the lateral wall. Then, CT scans with 3D reconstructions of the same patients were provided along with the radiographs and they were asked to classify the fracture again. Inter- and intra-observer agreement of the AO classification based on plain radiographs alone and once CT scan with 3D reconstruction was added to the plain radiographs was determined using Kappa coefficients. Pattern of change in classification on addition of CT scan to plain radiographs was also assessed. The mean kappa value for inter- and intra-observer agreement for AO classification on plain radiographs alone were 0.58 (moderate) and 0.66 (substantial), respectively. Upon addition of CT scan to plain radiographs, both improved to 0.70 (substantial) and 0.77 (substantial), respectively. The AO classification of the fracture changed 28.70% times (93 of 324 observations) upon addition of CT scan to plain radiographs. 96.77% times (90 of 93 observations) the classification was upgraded to higher group, while it was downgraded in only 3.22% times (3 of 93). 55.91% times this change was observed in AO 31 A 2 group (52 of 93 observations). In 17.59% cases (57 of 324 observations), fractures which were classified as stable (A1.1-A2.1) on radiographs alone, were reclassified as unstable (A2.2-3.3) upon addition of CT scan to plain radiographs. In 11.4% cases (37 of 324 observations), the lateral wall was classified as vulnerable or broken on CT scans where it was classified intact on plain radiographs. Addition of CT scans with 3D reconstructions to plain radiographs improves the intra- and inter-observer agreement of the AO classification. Addition of CT scan results in change in classification of the fracture in about one out of three cases. This most commonly happens in the AO 31 A 2 group. Most of the times, this results in the classification of fracture being upgraded. Many fractures which are initially classified as stable (A1.1-A2.1) on radiographs are reclassified as unstable (A2.2-3.3) on addition of CT scans. The lateral wall is also classified as vulnerable or broken more number of times on CT scans than plain radiographs alone. Therefore, we conclude that CT scan with 3 D reconstructions definitely helps in better pre-operative classification of intertrochanteric fractures especially in select group of fractures (AO 31 A 2) where stability and integrity of lateral wall is difficult to assess.

The current clinical practice of general orthopaedic surgeons in the treatment of lateral ankle sprain: a questionnaire survey in Miyazaki, Japan

BackgroundLateral ankle sprain (LAS) is one of the most common musculoskeletal injuries. Numerous studies regarding LAS have been performed. However, there are few studies evaluating the current clinical practice of orthopaedic surgeons regarding LAS. The purpose of this study was to evaluate the current clinical practice of general orthopaedic surgeons in the treatment of LAS.MethodsA questionnaire survey was conducted from September 2020 to December 2020 in Miyazaki, Japan, to evaluate the clinical practice of general orthopaedic surgeons in the treatment of LAS. The survey was composed of 12 questions that were developed with consideration of the recommendations in the current clinical practice guidelines (CPGs) published by the Dutch orthopaedic society. The questions in this study were focused on the diagnosis, conservative treatment, rehabilitation, and the criteria for return to sports (RTS).ResultsThe survey response rate was 82.7% (129/156). Among the respondents, 95.3% did not consider the Ottawa Ankle Rules in the decision to perform plain radiography for patients. Rehabilitation following LAS was performed in 58.9% of patients. Eighty-five (65.9%) of the surgeons used only one factor as the criterion for RTS. The absence of pain was the most frequently used criterion (45.7%). No objective criteria were used for the RTS decision in athletes with LAS.ConclusionsThe present study suggested that most general orthopaedic surgeons do not provide the care for patients with LAS recommended by the current CPGs. No objective criteria for the RTS decision are used for athletes with LAS.

How much is the effective dose from medical imaging in pediatric patients in the neurosurgery department?

Medical imaging with ionizing radiation in pediatric patients is rising, and their radiation sensitivity is 2–3 times more than adults. The objective of this study was to estimate the total effective dose (ED) of all medical imaging by CT scan and plain radiography in patients in pediatric neurosurgery department. Patients with at least one brain CT scan and recorded dose length product (DLP) were included. Patients’ imaging data were collected from the picture-archiving-and-communicating system (PACS) using their national code to find all their medical imaging. Total ED (mSv) from CT scans and plain radiographs were calculated. A total of 300 patients were included, of which 129 were females and 171 males with a mean age of 5.45 ± 4.34 years. Mean DLPs of brain, abdomen, and chest CT were 329.16, 393.06, 284.46 mGy.cm. The most frequent CT scans in these children were brain CT scans with ED range of 0.09 to 47.09 mSv. Total ED due to all CT scans and plain radiographs were in the range of 0.38 to 63.41 mSv. Although the mean DLP of each brain, chest, and abdomen CT of patients was in the range of DRLs reported by previous studies, the patients with numerous CT scans received more radiation doses than mean ED (6.21 mSv between all age groups). The most frequent CT scan was the brain, and the most frequent plain radiographs were chest and lower extremities. It can be concluded that reducing the number of CT scans or plain radiographs by appropriate physical exams or replacing them with modalities that do not use ionizing radiation can reduce ED.

Assessment of a novel computer software in diagnosing radiocarpal osteoarthritis on plain radiographs of patients with previous distal radius fracture

Osteoarthritis (OA) has primarily been diagnosed with plain radiographs assessed visually by examiners with regard to joint space width and presence of subchondral sclerosis, cysts and osteophytes. The increasing use of artificial intelligence has seen software developed to examine plain radiographs for diagnosing OA, based on observed OA-associated subchondral bone microarchitecture changes. A software for computerized texture analysis has been developed to identify knee OA. The aim of this study was to assess the software's ability to identify radiocarpal OA. Presence of radiocarpal OA on 63 wrist radiographs of patients with a previous distal radius fracture was assessed independently by two surgeons experienced in assessing radiographs, and classified according to Kellgren-Lawrence (38 OA, 25 no OA). First, the computer software, not previously trained to identify wrist OA, assessed presence of radiocarpal OA on the 63 radiographs. In a second step, 144 labeled wrist radiographs with and without radiocarpal OA was used to train the computer software. Presence of OA on the original 63 radiographs were then reassessed by the software. Sensitivity, specificity and area under the curve (AUC) were calculated to determine the software's ability to discriminate between cases with and without OA. Before training, sensitivity was 76% (95% CI 59-88), specificity 25% (10-47), and AUC 0.50 (0.35-0.65). After training, sensitivity was 46% (29-63), specificity 70% (47-87), and AUC 0.58 (0.43-0.73). The software for computerized texture analysis of subchondral bone developed to identify knee OA could not detect OA of the radiocarpal joint.

Classifications in Brief: The Dorr Classification of Femoral Bone.

Classifications in Brief: The Dorr Classification of Femoral Bone.

Is the Scotty Dog Sign Adequate for Diagnosis of Fractures in Pediatric Patients with Lumbar Spondylolysis?

Introduction Recent advances in diagnostic imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), have allowed early diagnosis of lumbar spondylolysis (LS). However, few outpatient clinics are equipped with such imaging apparatuses and must rely on plain radiographs for the diagnosis of LS. The aim of this retrospective study was to identify how accurately fracture lines can be detected on plain radiographs in patients with LS. MethodsPatients with a diagnosis of LS were staged as early, progressive, or terminal. We evaluated whether fracture lines could be detected on plain radiographs and compared the detection rates under the following conditions: two directions including anteroposterior and lateral views (2 views), four directions including both oblique views (4 views), four directions including dynamic lateral views (4-D views), and all six directions (6 views). Results In early LS, the fracture line detection rate was 11.4% using 2 views, 20.5% using 4 views and 4-D views, and 22.7% using 6 views. In progressive LS, the fracture line detection rate was 54.2% using 2 views, 70.8% using 4-D views, 75.0% using 4 views, and 79.2% using 6 views. The respective detection rates for terminal LS were 85.0%, 100%, 100%, and 100%. Conclusions Although terminal LS was diagnosed accurately on plain radiographs in all patients, the detection rates were only 22.7% and 79.2% in patients with early and progressive LS, respectively. These results suggest that plain radiographic films can no longer be considered adequate for early and accurate diagnosis of LS. Advanced imaging procedures, such as MRI in the early diagnosis or CT for persistent cases, are recommended to obtain an accurate diagnosis of early stage LS in pediatric patients requiring conservative treatment to achieve bony healing.

Chronic rhinosinusitis: the correlation between symptom severity score and findings on plain radiographs of the paranasal sinuses

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic rhinosinusitis (CRS) is a common clinical problem with often refractory symptoms. Though computed tomography scan of the paranasal sinuses (PNS) is the radiological gold standard for confirming the diagnosis of CRS, it is not readily available and affordable in developing countries. Hence plain radiographs are heavily relied upon to confirm the diagnosis of CRS. The reliability and adequacy of plain sinus radiographs in combination with disease specific questionnaires in the management of CRS is still debatable. The objectives of the study were to determine the correlation between symptom severity score and findings on plain radiograph of the PNS in adult patients with CRS.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was an eight month prospective cross sectional study (April-November, 2014) of Fifty- two consecutive newly diagnosed adult patients with CRS. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Age of patients ranged from 19–91 years. Male to female ratio was 1:1.26. There was significant positive correlation between high and moderate symptom severity score (severe and moderate disease) with findings on plain radiograph of the PNS (p=0.032 and 0.048 respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The overall symptom severity score of CRS correlates with findings on the plain radiographs of patients with CRS especially in severe and moderate disease. &lt;/p&gt;

Plain radiography in patients treated with intrathecal drug delivery using an implantable pump device

ObjectivesIntrathecal drug administration using an implanted pump system is well established in intractable spasticity and pain. However, despite continuous advancements in manufacturing technology, adverse events related to the pump and catheter still occur. Most of them, such as migration, damage, disconnection and occlusion, are related to the spinal catheter. The aim of this overview is to update radiologists on how plain radiography of the implanted delivery system for intrathecal drug administration should be interpreted and to increase awareness for the need of urgent and timely multidisciplinary troubleshooting.MethodsPlain radiographic images of patients treated with intrathecal drug administration using an implantable drug delivery system were analysed in a multidisciplinary setting at our (university) referral centre for complications in intrathecal drug administration.ResultsExamples of catheter-related adverse events are described and a proposal is made for stepwise interpretation of standard plain radiographic images.ConclusionsPlain radiological images are the mainstay for the diagnosis of catheter-related adverse events in intrathecal drug delivery. Radiologists play an important role in an early diagnosis. An awareness of abnormal radiological findings seems important to avoid a life-threatening withdrawal syndrome.Teaching points• Untimely cessation of intrathecal drug delivery can lead to a life-threatening withdrawal syndrome.• Initially mild symptoms can lead to an exacerbation of a withdrawal syndrome.• Most intrathecal catheter-related problems are visible on plain radiography.• Common causes of catheter problems are migration, lacerations, occlusion and disconnection.• Knowledge on implanted intrathecal catheters is crucial for interpretation of plain radiography.

Delayed leg paraplegia associated with hyperextension injury in patients with diffuse idiopathic skeletal hyperostosis (DISH): case report and review of the literature

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcifications and ossification of ligaments and tendon insertions. The patients with DISH are susceptible to spinal column injury with trivial trauma due to immobilization of vertebrae and this easily leads to spinal cord injury. However, only few reports on hyperextension injuries of the thoracolumbar spine with DISH exist. Here we report three cases of those who developed delayed leg paraplegia after hyperextension injuries of the thoracolumbar spine with DISH. All cases complained only lower back pain without neurological deficits and plain radiographs showed no fractures at an initial assessment. The spinal fracture caused by hyperextension injury was diagnosed with computed tomography (CT) and magnetic resonance image (MRI) after delayed leg paraplegia occurred. Many of the fractures caused by hyperextension injuries are not detected only with plain radiographs in patients with DISH. Further investigations using CT and/or MRI should be recommended.

Radiologic Assessment of Scaphoid Dorsal Translation in Patients With Scapholunate Instability

Objective/Hypothesis: The objective of this study is to radiographically assess scaphoid dorsal translation in patients with scapholunate instability. We hypothesized that (1) there is a significant difference in scaphoid dorsal translation in lateral plain radiographs in patients with scapholunate instability when compared with controls, (2) magnetic resonance imaging (MRI) will correlate with radiographic dorsal scaphoid translation measurements in patients with scapholunate instability. Materials and Methods: This was a retrospective case-controlled study of 24 patients with scapholunate ligament (SLIL) injury. Five carpal alignment indices were assessed on radiographs: scapholunate gap in clenched pencil view, scapholunate angle, radiolunate angle, scaphoradial angle, and scaphoid dorsal translation. Scaphoid dorsal translation was defined as the distance (mm) between the centers of the best fit circles for (1) the scaphoid proximal articular surface and (2) the scaphoid fossa, using the external palmar cortex of the radius as the orientation axis. Two examiners measured these radiographic indices, and interobserver reliabilities were determined and expressed as intraclass correlation coefficient (ICC). For convergent validity testing, the correlation between the radiograph dorsal translation and dorsal translation in MRI was assessed. Independent sample t test was used to compare the alignment indices between cases and controls. Results: Significant differences were found between the cohorts in the following measurements: scapholunate angle ( P = .001), scaphoradial angle ( P = .04), and scaphoid dorsal translation (mm) ( P ≤ .001). However, no difference was found between groups for the radiolunate angle measurement ( P = .665). Interobserver reliability for scaphoid dorsal translation in radiographs and MRI was excellent with ICCs of .82 and .92, respectively (95% confidence interval [CI], 0.565-0.925, and 0.111-0.914, respectively). The correlation between radiographs and MRI scaphoid dorsal translation was moderate for reader 1 with ICCs of .505 (95% CI, 0.021-0.161) and excellent for reader 2 with ICCs of .908 (95% CI, 0.135-0.968). Conclusions: This study introduces a new radiographic parameter, scaphoid dorsal translation, in patients with diagnoses of scapholunate instability. This parameter is, theoretically, the most correlative to symptoms as it shows whether the joint is statically subluxated. Radiographic scaphoid dorsal translation is correlated with MRI findings and might represent a lower cost option for early detection of the radioscaphoid joint eccentric wear seen in some stages of scapholunate instability.

Diagnostic value of plain radiographs in patients with low back pain of non-traumatic origin at a national teaching and referal hospital in Kenya

Background: Low back pain is a commonly recognized problem worldwide. Plain radiography is used in many of these patients as an initial investigative and evaluative tool. However, it was not known how truly useful this investigation was in making definitive diagnosis for non traumatic low back pain. The main objective of the study was to determine the value of plain radiographs in patients presenting with low back pain that is of non-traumatic origin.Methods: A prospective study 102 consecutive patients with low back pain was conducted at the Kenyatta National Hospital (KNH) from 1st February 2013 to 30th May 2013. Data was collected using a structured questionnaire and analyzed. Plain radiograph films were reviewed by two qualified radiologists.Results: The mean age of patients presenting with low back pain was 50.9years, with a male to female ratio of 1:2.4. Majority of the patient had chronic low back pain. There was a high rate of positive radiological findings (98%). The most common findings included muscle spasm, osteoporosis, reduced lumbar lordosis, spondylosis, disc degenerative disease and osteophytes. Assessment of inter-rater variability showed good level of agreement on presence of spondylolisthesis and vacuum phenomenon (k=0.71), moderate agreement on reduced disc space, reduced lumbar lordosis, spondylosis (k=0.42-0.56) and poor agreement on film quality, infections, tumor metastasis, osteophytes, prolapsed intervertebral disease (PID), osteoporosis, scoliosis, muscle spasm and sacroilitis (k=0.13-0.21)Conclusion: Most of the patients presenting to KNH with low back pain have a chronic type and therefore have increased probability of having positive radiological findings. There was a poor ability to diagnose infectious causes, inflammatory conditions, transitional vertebrae and tumor metastasis. In such cases, more advanced imaging such as CT scan and MRI may be required.

Imaging features of medicine-related osteonecrosis of the jaws: comparison between panoramic radiography and computed tomography

The current staging system of medicine-related osteonecrosis of the jaws (MRONJ) assigns patients to different stages based on clinical manifestations. The extent of bone disease cannot be fully determined without radiologic evaluation. Missing radiologic information may lead to incorrect classification of MRONJ, resulting in poor outcomes of treatment. The objective of this study was to compare computed tomography (CT) and panoramic radiography (PR) features of MRONJ in different stages to achieve accurate staging on the basis of combined findings from clinical staging and imaging. A retrospective study was carried out to analyze the differences in the radiographic features of various clinical stages in MRONJ, as shown by PR and CT. Both PR and CT could detect the typical syndrome of osseous sclerosis in grade 0 and grade 1. For the patients of grade 2, more features were observed on CT, such as periosteal reaction, cortical perforation, and periosteal bone deposition. CT was also conducive to analyzing the degree of the maxillary lesion and soft tissue involvement as compared with PR. This study showed that CT detects changes that may not be revealed by plain radiography in patients with MRONJ.

Quality-controlled dose reduction of full-leg radiography in patients with knee malalignment.

Digital plain radiographs of the full leg are frequently performed examinations of children and young adults. Thus, the objective of this work was to reduce the radiation exposure dependent on specific indications, and to determine objective quality-control criteria to ensure accurate assessment. Institutional review board approval and informed consent of all participants were obtained. In this prospective, randomized controlled, blinded, two-armed single-center study, 288 evaluable patients underwent plain radiography of the full leg with standard and reduced doses. The evaluation of the plain radiographs was conducted using the following criteria: mechanical axis, leg length, and maturation of the epiphyseal plate. Two blinded radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If a single criterion had been evaluated with a score of 3 or more points or all criteria with 2 points, the radiograph was scored as "not assessable". The study was designed as a non-inferiority trial. Eleven (3.8%) examined X-rays were scored as not assessable. The rate of non-assessable radiographs with 33% reduced dose was significantly not inferior to the rate of non-assessable radiographs with standard dose. The evaluation of the quality criteria was dose independent. Full-leg plain radiography in patients with knee malalignment can be performed at 33% reduced dose without loss of relevant diagnostic information.