Portable X-ray Machine Research Articles

Provision of dental care in the military medical service of the armed forces of the Russian Federation during a military operation

This article analyzes the scope of services provided by a dentist within the military medical service of the Armed Forces of the Russian Federation during a modern armed conflict. The study included two stages: a prospective stage involving patient care (preventive oral cavity examinations in citizens mobilized for military service) and a retrospective analysis of dental care provided by the military medical service during a military operation (data from preventive examinations, oral sanitation plans for armed forces personnel, and reports from senior dentists of military districts). It has been established that the need for oral sanitation among career military personnel averages 72% and reaches up to 81% among volunteers and citizens mobilized for military service, increasing the workload for both military and hospital dentists. On average, 85.4% of armed forces personnel require outpatient dental care, with each individual having an average of 5.6 teeth requiring treatment: 3.8 for caries, 0.8 needing endodontic treatment, 1 tooth requiring extraction, and 7.4 teeth needing restoration among those requiring prosthetics. It was noted that the critical factors were the nature of combat operations, the workload of medical evacuation stages, and the availability of various resources in the regimental aid station or the medical company of a brigade. These factors often hinder the full deployment of dental equipment and the ability to provide treatment for oral disorders, both on an elective and emergency basis. Satisfactory conditions for this type of medical care are achievable only in a dental office within a separate medical battalion or a special task medical detachment. To improve the provision of dental care to armed forces personnel by the military medical service of the Armed Forces of the Russian Federation during a military operation, the authors propose the following. Dental offices should be equipped with portable turbine dental units, which have proven to be highly effective in real combat conditions, and with portable dental X-ray machines to significantly improve the quality of diagnostics and treatment of dental disorders. In addition, given the challenges of restocking medical consumables, dentists should ensure their timely requisition and monitoring their receipt, since only 36.6% of medical units are equipped with standard dental consumables, necessitating urgent measures to establish a stable supply system.

Efficiency of Artificial Intelligence for Interpretation of Chest Radiograms in the Republic of Tajikistan

The article presents data from recent publications and own data on screening studies with interpretation of chest radiographs using artificial intelligence CAD (Computer-Assisted Diagnosis), which, according to WHO recommendations, provides more accurate clinical thresholds for deciding who needs to take a sputum test. Another aspect of the WHO recommendations is the cost-effectiveness of CAD as a tool for triaging patients with tuberculosis symptoms in low-income countries with a high incidence of tuberculosis. Compared with smear microscopy and GeneXpert, without preliminary sorting, the use of mobile digital X-ray machines equipped with a CAD tool reduces costs, allowing sorting of individuals suspected of having tuberculosis for testing on GeneXpert, while reducing the time to start tuberculosis treatment. Thus, conducting a study using portable X-ray machines using a CAD program is a low-cost and easy-to-implement method, does not require large funds, does not require separate rooms, is highly effective, has good image quality, allows you to quickly clarify individuals suspected of having tuberculosis, differentiating it from other pathological changes in the lungs. Our experience shows that machine analysis of chest computed tomography data, due to the higher resolution capabilities of the method and the absence of fundamental disadvantages of radiography, including the effect of shadow summation, the presence of “blind” zones, etc., is finding increasing application in both diagnostics and screening of respiratory diseases. Our use of this tool allowed us to identify additional new cases of phthisio-onco-pulmonary diseases in field conditions.

Implementation of Portable Digital Chest X-ray Machine for Tuberculosis Contact Tracing in Oyo and Osun States, Nigeria: A Formative Assessment

This paper presents a formative assessment for the implementation of mobile portable chest X-ray (PDX) machines for tuberculosis (TB) contact tracing in the Oyo and Osun states, Nigeria. This descriptive qualitative study was carried out in eight local government areas, and 24 focus group discussions and 30 key informant interviews were conducted using a four-stage sampling technique to select participants. Validated transcribed notes were entered and analyzed using Nvivo. The respondents’ ages ranged from 17 to 85 years, with a mean age of 42.08 ± 14.9 years, and 4.0% had a postgraduate degree. The majority of government officials stated that deploying the PDX machine for screening at the community level is the best means for implementation because it will offer a level of proximity convenience to the TB contacts and assuage concerns about the cost of transportation to the health facility. In addition, it was suggested that TB community screening should be carried out with screening for other health conditions such as high blood pressure and diabetes. This portable X-ray machine intervention, therefore, should be implemented at the community level for contact tracing to allow more TB contacts living with the index patient to be screened without proximity and transportation constraints.

Assessment of coffee leaves nutritive value via portable X-ray fluorescence spectrometry and machine learning algorithms

Portable X-ray fluorescence (pXRF) spectrometry is a non-destructive technique that has been successfully used to analyze different matrices. Foliar analysis is challenging because some plant nutrients cannot be detected by pXRF. Even so, the uptake interactions among nutrients which reflect different concentrations of macro- and micronutrients can be accessed via pXRF, constituting a basis to obtain predictive models of plant nutrients. The objective of this work was to compare and assess the accuracy of linear regression and non-linear models (support vector machine – SVM; and random forest – RF) to predict the actual concentration of macro- (N, P, K, Ca, Mg, and S) and micronutrients (B, Cu, Fe, Zn, and Mn) in coffee leaves. A greenhouse experiment was conducted using Hoagland and Arnon solution to obtain leaves with contrasting elemental composition. Ground and oven-dried leaf samples were analyzed via pXRF using: i) a manufactured pXRF calibration developed for general earth-materials (Geoexploration mode); ii) the Spectrometer mode with varying voltage and current (15 kV and 25 μA; 10 kV and 10 μA). The same samples were also analyzed via conventional acid digestion and quantified via inductively coupled plasma-optical emission spectroscopy (ICP-OES). The best predictions were obtained using SVM and RF algorithms, with high R2 (0.82 to 0.99) and high residual prediction deviation (RPD) (2.35 to 9.34) values. However, some elements (e.g., K, Ca, Cu, Mn) were successfully predicted using linear models (LR and MLR). Even elements not detected (N and B) by pXRF were accurately predicted using the RF model. The pXRF operational conditions influenced the performance of the models. However, by parsimony, Geoexploration mode provided data for accurate prediction of macro- and micronutrients. This comprehensive study can potentially spark further investigations into examining coffee leaves from plants cultivated under various environmental and management conditions. Additionally, the methodological framework outlined here holds promise for ongoing experimentation across diverse crops, offering a streamlined, non-invasive, eco-friendly, and rapid approach for foliar analysis.

Marie Curie: Forged in the Name of Science

The most common name that is used by the feminist movement is Marie Curie's name as the first woman who conquered the men's world at that time (i.e. science). A deep and thorough investigation of the historical facts from first-source witnesses and physical evidences will prove what Marie Curie did and what her real achievements are. Where did she learn and earn her degrees? If there are any. Did she marry her professor? How did her husband die in a mysterious way? Was she involved in his death? Did she cheat on her husband? Did she have any sexual affairs with junior staff members? Why did the French Academy of Science (i.e. 100 scientists, professors, and doctors) voted to reject her application for membership in the academy? Why did the French public protest against her? Why did she work as a radiographer on a portable X-ray machine to image the wounded French soldiers? Was that a strategy to absorb the public heat? Was any of this have to do with anti-Semitism? Were her achievements exaggerated in the media? How did she win a Nobel Prize in physics and another Nobel Prize in chemistry? All these questions will be answered in this paper based on strong evidences. Naomi Pasachoff wrote a biography where she made Marie Curie a hero! But was she a hero? This paper will highlight all the propaganda written about this individual.

Hand-held GPU accelerated device for multiclass classification of X-ray images using CNN model

Chest X-ray (CXR) images are the primary investigation aid for many lung diseases and their follow-ups. For diagnosis of SARS-CoV-2, RT–PCR test and chest Computed Tomography (CT) are commonly used but both face false negatives for ruling out the infection. So, there is a demanding need for developing a system combined with Artificial Intelligence (AI) and CXR imaging to detect COVID-19 patients to avoid its spread. Here, a robust and efficient handheld device is proposed. It uses the computational power of the Graphics Processing Unit (GPU) and pre-trained deep learning models for analyzing the CXR images. A Resnet-50 CNN model is deployed on an NVIDIA Jetson Nano GPU module for the real-time classification of COVID-19, Tuberculosis, and Normal using CXR images. The device can perform real-time classification of CXR images from a portable X-ray machine and classify the image into one of the above categories. For the extensive training, a database of 680 COVID-19, 1230 Tuberculosis, and 1050 normal CXR images are extracted by combining several global databases like Kaggle, SIRM, RSNA, and Radiopaedia. The classification accuracy, precision, and loss rate were 0.9879, 0.9758, and 0.0196 respectively and our model would improve with larger data sets. The highly accurate and high-performance GPU device significantly plays a far-reaching role in COVID-19 diagnosis using Chest X-ray, which could be beneficial to triage the health system and to combat the outbreak of COVID-19.

Radiology Department: A Potential Source of Multidrug-Resistant Microorganisms: A Cross-Sectional Study at Tertiary Hospital, Palestine.

Globally, healthcare facilities face a great challenge in the form of hospital-acquired infections (HAIs). Aside from the morbidity and mortality they cause, these illnesses are also extremely costly. Research on infection transmission in the medical field has been considerable, but not so much in the radiology department. This study aims to identify the presence of multidrug-resistant (MDR) microbes on surfaces that are frequently touched in computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), plain X-ray examination rooms, and portable radiography that are susceptible to contamination as well as to investigate the potential dangers of contracting MDR organisms to patients and healthcare providers. Materials and Method. In this study, 160 swab samples were collected from the radiology department during May and June 2022. Samples were obtained from 80 predefined surfaces twice within and outside of CT and MRI examination rooms as well as from US and plain X-ray machines and portable X-ray machines. Samples were taken at 7:00 a.m. using cotton swabs following the regular cleaning procedure. Bacterial colony-forming units (CFUs) per square centimeter were calculated after swabbing a 100 cm2 surface. Nearly all of the surfaces tested had bacterial CFUs. The highest contamination rate was found on keyboards ranging from (1.2-8) CFU/cm2, the sides of patient tables (1.2-20) CFU/cm2, knee coil (2.4-3) CFU/cm2, and patient leg supports (1.2-8) CFU/cm2. A noticeable increase in the contamination was noticed in June compared to May, and this was consistent with the increase in the number of isolated patients in the hospital, the workload in the radiology department, and the number of patients referred to the hospital. In our study, none of the examined sites showed contamination with MDR Gram-negative bacteria such as extended-spectrum beta-lactamases producing Enterobacterales (ESPL) or Carbapenemase-producing Enterobacterales (CPE). On the other hand, methicillin-resistant Staphylococcus (MRS), vancomycin-resistant Staphylococcus (VRS), and vancomycin-resistant Enterococcus (VRE) were detected. All of the radiology department equipment and sites could be a source of bacterial infection including MDR, so the obligatory and committed disinfection protocol must be revised and implemented in the morning and between patients.

Role of emergency teleradiology in a mass motorcycle event: the experience of the 2021 International Six Days of Enduro (ISDE).

Provision of healthcare support at mass gathering sporting events is of paramount importance for the success of the event. Many of such events, like motorsports, have been increasingly taking place in remote and austere environments. In these settings, the use of first-line diagnostic tools, such as point of care ultrasound and portable X-ray, could aid in definitive care on the field for patients with minor trauma while also ensuring fast access to the appropriate level of care for patients requiring hospitalization. As part of the ISDE 2021 medical response plan, a field hospital equipped with portable digital X-ray and telemedicine was established. Data on patient admission, triage, treatments, diagnostics, and outcomes were collected for analysis. During the 6-day competition, 79 patients sought medical care at the field hospital, with traumatic injuries accounting for 77% of cases. Of these, 47 were athletes and 32 were non-athletes. The majority (91%) arrived spontaneously, while 9% were transported directly. Upon admission, 68 patients were triaged as non-urgent (code 3) and 11 as urgent (code 2). Of those admitted, 69 received treatment and were discharged at the field hospital, while 10 were transferred elsewhere. Notably, four patients had major trauma, two had isolated fractures, and one needed a CT scan after losing consciousness. Overall, 29 missions were conducted on the race field, including 13 primary transports to local hospitals and 6 to the field hospital. Primary transport was primarily due to major trauma. Among 31 patients who had radiological exams, 11 (35.5%) had traumatic injuries. Of these, 5 were treated with braces and casts and discharged without hospitalization, 3 were advised for post-event care, and 3 were hospitalized. In contrast, patients with negative X-rays received on-site treatment, with 7 able to continue competing. In summary, the successful implementation of portable X-ray machines and teleradiology at remote and austere high-risk sporting events holds great promise for enhancing on-site medical capabilities, allowing clinicians informed decisions, avoiding unnecessary hospitalization, and allowing athletes to continue with their competition. Provided that challenges related to cost, safety, connectivity, and power supply are effectively addressed.

Proximal sensing provides clean, fast, and accurate quality control of organic and mineral fertilizers

Farms use large quantities of fertilizers from many sources, making quality control a challenging task, as the traditional wet-chemistry analyses are expensive, time consuming and not environmentally-friendly. As an alternative, this work proposes the use of portable X-ray fluorescence (pXRF) spectrometry and machine learning algorithms for rapid and low-cost estimation of macro and micronutrient contents in mineral and organic fertilizers. Four machine learning algorithms were tested. Whole (i.e., as delivered by the manufacturer) (CP) and ground (AQ) samples (429 in total) were analyzed to test the effect of fertilizer granulometry in prediction performance. Model validation indicated highly accurate predictions of macro (N: R2 = 0.92; P: 0.97; K: 0.99; Ca: 0.94, Mg: 0.98; S: 0.96) and micronutrients (B: 0.99; Cu: 0.99; Fe: 0.98; Mn: 0.91; Zn: 0.94) for both organic and mineral fertilizers. RPD values ranged from 2.31 to 9.23 for AQ samples, and Random Forest and Cubist Regression were the algorithms with the best performances. Even samples analyzed as they were received from the manufacturer (i.e., no grinding) provided accurate predictions, which accelerate the confirmation of nutrient contents contained in fertilizers. Results demonstrated the potential of pXRF data coupled with machine learning algorithms to assess nutrient composition in both mineral and organic fertilizers with high accuracy, allowing for clean, fast and accurate quality control. Sensor-driven quality assessment of fertilizers improves soil and plant health, crop management efficiency and food security with a reduced environmental footprint.

Radiation dose to staff from scatter radiation in the post-anaesthetic recovery ward

IntroductionThough recovery is a significant aspect of the post-surgical orthopaedic patient pathway, radiation dose from medical imaging to staff within the post-anaesthetic recovery unit, is not extensively researched. This study aimed to quantify the distribution of scatter radiation for common post-surgical orthopaedic examinations. MethodsA Raysafe Xi survey meter was used to record scattered dose at various locations around an anthropomorphic phantom, with positions simulating the potential positions of nearby staff and patients. X-ray projections of the AP Pelvis, Lateral Hip, AP and lateral knee were simulated using a portable x-ray machine. Readings were tabulated and diagrams drawn representing the distribution of scatter measurements from each of the four procedures. ResultsMagnitude of dose was dependent on imaging parameters (ie. kVp and mAs), the area of body exposed (ie. hip or knee), and the type of projection (ie. AP or lateral). Knee exposures proved much lower than hip exposures at any distance from the radiation source. ConclusionMaintaining a two-metre distance from the x-ray source was justified most profoundly by the hip exposures. Staff should have confidence that occupational limits will not be reached with adherence to the practices suggested. This study provides comprehensive diagrams and dose measurements with the aim of educating staff working around radiation.

Effectiveness of protective thyroid shield in chest X-ray imaging

Chest X-ray imaging is the most common X-ray imaging method for diagnosing coronavirus disease. The thyroid gland is one of the most radiation-sensitive organs of the body, particularly in infants and children. Therefore, it must be protected during chest X-ray imaging. Yet, because it has benefits and drawbacks, using a thyroid shield as protection during chest X-ray imaging is still up for debate.Therefore, this study aims to clarify the need for using a protective thyroid shield during chest X-ray imaging. This study was performed using different dosimeters (silica beads as a thermoluminescent dosimeter and an optically stimulated luminance dosimeter) embedded in an adult male ATOM dosimetric phantom. The phantom was irradiated using a portable X-ray machine with and without thyroid shielding. The dosimeter readings indicated that a thyroid shield reduced the radiation dose to the thyroid gland by 69% ± 18% without degrading the obtained radiograph. The use of a protective thyroid shield during chest X-ray imaging is recommended because its benefits outweigh the risks.

Frequency of occurrence of taurodontism in the historical population of Radom (11th−19th centuries)

ObjectiveThe aim of the work was to trace possible changes in the frequency of taurodontism in individuals who inhabited historical Radom from the early Middle Ages to modern periods. DesignThe research was based on the analysis of X-ray images of 640 molars of individuals from the 11th/12th c. (n = 120), 14th/17th c. (n = 76), and 18th/19th c. (n = 444). Radiological images were made with the use of a portable X-ray machine, and the results were biometrically analysed using the Shiffman and Chanannel index. ResultsThe highest frequency of taurodontism was observed in the 18th/19th c. (31 %, 138/444). In the 11th/12th and 14th/17th centuries, this percentage was significantly lower (22 %, 26/120 vs. 16 %, 12/76). In subsequent chronological periods, no statistically significant differences between sexes in the occurrence of taurodontism were observed. The highest number of taurodontal teeth was observed among the second and first upper molars (73 % and 52 %, respectively), and the lowest number was observed among the first and second lower molars (16 % and 23 %, respectively). In all historical periods, hypotaurodont forms were most often observed. ConclusionsVariations in the frequency of taurodontism may result from many reasons, for example environmental factors. However, it cannot be ruled out that the observed differences result from the increased migration of people to Radom in the 18th/19th century.

Radiation dosimetry with a Triple-GEM detector

We studied the properties of the gaseous detector triple-GEM (triple Gas Electron Multiplier) as a dosimeter with different ionizing radiation sources used in medical applications. The detector was calibrated in energy with an Iron-55 radioactive source. We measured doses of radiation from different radioactive sources as well as from a medical portable X-ray machine, and compared them to reference values. The detector presents a linear dependence between radiation intensity and measured dose. A calibration factor of 1.13x104 was found, independently of the radiation source. These results allow us to conclude that the triple-GEM detector has the potential to be used as a dosimeter in medical applications.

A comparison of the quality of images of chest X-ray between handheld portable digital X-ray & routinely used digital X-ray machine.

Chest X-ray (CXR) is an important screening tool for pulmonary tuberculosis (TB). Accessibility to CXR facilities in difficult-to-reach and underserved populations is a challenge. This can potentially be overcome by deploying digital X-ray machines that are portable. However, these portable X-ray machines need to be validated before their deployment in the field. Here, we compare the image quality of CXR taken by a newly developed handheld X-ray machine with routinely used reference digital X-ray machine through the conduct of a feasibility study. A total of 100 participants with suspected pulmonary TB were recruited from the outpatient departments of a medical college and a community health centre in Agra. Each participant underwent CXR twice, once with each machine. Both sets of de-identified images were independently read by two radiologists, who were blinded to the type of X-ray machine used. The primary outcome was agreement between image qualities produced by these two machines. The intra-observer (radiologist) agreements regarding the status of the 15 CXR parameters ranged between 74 per cent and 100 per cent, with an unweighted mean of 87.2 per cent (95% confidence interval: 71.5-100). The median Cohen's kappa values for intra-observer agreement were 0.62 and 0.67 for radiologists 1 and 2, respectively. In addition, on comparison of the overall median score of quality of the image, the handheld machine images had a higher score for image quality. The current study shows that a handheld X-ray machine, which is easy to use and can potentially be carried to any area, produces X-ray images with quality that is comparable to digital X-ray machines routinely used in health facilities.

Radiographic and ultrasonic study of pelvic bones in awassi ewes and local she goat and relationship with age of sexual puberty

Thegoal of this study is to find out the age of sexual puberty in Awassi sheep and native black she goats by examining pelvic bone development which is obtained from measuring the transverse and vertical diameters of the pelvic bone in the two species using portable X-ray machines American origin.in addition, the length and width of the ovaries were measured with an ultrasound rectal probe. To achieve the goal of this study, six Awassi sheep and the same number of local goats were used. Radiographs were taken of each animal in the ventro-dorsal position, then the mean and standard error of each measurement in the two species were extracted. The rectal probe of the ultrasound machine was also used by inserting it into the rectum, taking vertical and transverse ovarian measurements, and then extracting the mean of each measurement along with the standard error. The mean transverse and vertical diameter measurements at the first instances of sexual puberty in Awassi sheep were 7.70±0.09 cm and 10.61±0.03 cm, respectively, and the mean ovarian length and width were 1.20±0 .08, 0.80±0.06 cm respectively. While the average distance to the transverse pelvic inlet and the pelvic inlet vertically in local black goats at age of sexual maturity were 7.15±0.06 cm and 10.55±0.10 cm, respectively, and the average length and width of the ovary was 1.66±0.03, 1.24±0.02 cm respectively. The results in both species showed that the age of sexual maturity is earlier in Awassi sheep than in local black goats.

Development of a contactless operation system for radiographic consoles using an eye tracker for severe acute respiratory syndrome coronavirus 2 infection control: a feasibility study

<p class="Abstract">Sterilization of medical equipment in isolation wards is essential to prevent the transmission of severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2) infection. Particularly, the radiographic console of portable X-ray machines requires frequent disinfection because it is regularly moved; this requires considerable infection control effort as the number of patients with coronavirus disease 2019 (COVID-19) increases. To evaluate the application of a system facilitating noncontact operation of radiographic consoles for patients with COVID-19 to reduce the need for frequent disinfection. We developed a noncontact operation system for radiographic consoles that used a common eye tracker. We compared calibration errors between with and without face shield conditions. Moreover, the use of console operation among 41 participants was investigated. The calibration error of the eye tracker between with and without face shield conditions did not significantly differ. All (<em>n</em> = 41) observers completed the console operation. Pearson’s correlation coefficient analysis showed a strong correlation (<em>r</em> = 0.92, <em>P</em> < 0.001) between the average operation time and the average number of misoperations. Our system that used an eye tracker can be applied even if the operator uses a face shield. Thus, its application is important in preventing the transmission of infection.</p>

Role of Embedded System for X-Ray comparison of lungs to detect a COVID-19 affected person at the entry point of Aerodromes, Railway Stations and Metro Stations in perspective of India.

Nowadays, the biggest threat to mankind is COVID-19. This is a disease caused by severe acute respiratory syndrome coronavirus 2, SARS-Co V-2. It is must to control and stop the spreading of this disease. This paper is proposed to control the spread of this pandemic at the entry point of railway stations, metro stations, and aerodromes. The testing of COVID-19 is the most significant remedy to control, contain and reduce the COVID-19 pandemic. This paper proposes an embedded system design, which can be used at the entry point of aerodromes, railway stations, and metro stations, especially from an Indian perspective. This system can be used to analyze x-ray results of the lungs of the passenger who is entering the railway stations, aerodromes, and metro stations. The proposed system comprises a portable X-ray machine and an embedded system which consists of a Raspberry Pi Board ( Model B), that will be interfaced with a data input module, SD card slot, display monitor at HDMI port, LEDs, and buzzers. The system compares the passenger's X-ray image at the entry point of railway stations, aerodromes, and metro stations with the X-ray image of a COVID-19 patient, which is already stored in the SD card. If the similarity is found between the X-ray image taken at entry and the X-ray of a COVID-19 patient, at that moment, buzzers and LEDs will be activated. This system can be very much useful to restrict the spreading of infection of COVID-19.

Lessons learned from a bouffant surgical cap.

As a medical student rotating through the emergency department, I would often don a bouffant surgical cap before stepping into the trauma bay to observe as a patient was rolled into the room. How strange those caps made of polypropylene seemed to me: the individual fibers so thin and woven in a pattern that seemed like disarray. How could a thing so flimsy be helpful to our patients? On my first day of the rotation, the emergency department itself seemed like a reflection of those caps: the clatter of portable x-ray and EKG machines wheeled around the hallways, the clamor of consultants hurrying in and out of rooms, the patients clustered in the waiting room and crowded into hallway beds as providers rushed to see the next patient needing the most acute care. But as I observed the emergency department during the month of that rotation, the seemingly random jumble of patients mixed with providers settled into place. In just one afternoon: a nurse charged into a patient room to alert a doctor about another patient close to crashing in the room next door. Several consultants gathered at the nurse’s station so the charge nurse could join them to coordinate a plan for a patient in their shared care. The x-ray technician wheeled over the machine to the doctors’ row of computers to point out a concerning finding on the screen so that the problem can be quickly addressed. Respiratory technicians adjusted ventilator settings and then communicated changes in patients’ status to the physicians moving between patient rooms, giving updates on those patients who needed attention most urgently to help busy physicians with triage. A paramedic waved at a nurse for her attention to prioritize grabbing medications for a patient whose blood pressure needed more than just the bag of fluids that was infusing. The intensity and pace of the emergency department makes it appear like commotion. By the nature of emergency situations where the first goals are making certain patients are breathing and keeping their hearts beating, some disarray can be expected. But then watch an interprofessional team perform the primary and secondary survey of a trauma—such a synchrony of motion between physicians, anesthesiologists, surgeons, nurses, and radiographers that professional performers would stare in awe—and realize there is far more organization than may at first appear, and that collaboration is at the true center of the emergency department. Now, as a hospitalist who cares for admitted patients, I appreciate that, while the process in the emergency department is different from the step-by-step organization of inpatient medicine, with its routine of formal rounds, then placing consults, then getting orders entered, the nature of the emergency department calls for these things to happen at the same time. It is all these things happening together, guided by the hands of emergency department providers skilled at coordinating each simultaneous piece of care, that makes certain our patients seeking emergency help are well cared for. Like a polypropylene bouffant cap, at first glance the emergency department may seem like a place where the individual fibers comprising it are flimsy and woven together at random. But try to pull apart a bouffant cap and realize that the fibers do not tear so easily. The threads of the emergency department staff are like the fabric of those caps; each thread essential but also relying on connections between one another to be strong as a whole. It is this strength of multidisciplinary teamwork among providers all striving toward the goal of achieving positive health outcomes that facilitates the best possible patient care.

Augmented Reality-Based Visual Cue for Guiding Central Catheter Insertion in Pediatric Oncologic Patients.

Pediatric hemato-oncologic patients require central catheters for chemotherapy, and the junction of the superior vena cava and right atrium is considered the ideal location for catheter tips. Skin landmarks or fluoroscopic supports have been applied to identify the cavoatrial junction; however, none has been recognized as the gold standard. Therefore, we aim to develop a safe and accurate technique using augmented reality technology for the location of the cavoatrial junction in pediatric hemato-oncologic patients. Fifteen oncology patients who underwent chest computed tomography were enrolled for Hickman catheter or chemoport insertion. With the aid of augmented reality technology, three-dimensional models of the internal jugular veins, external jugular veins, subclavian veins, superior vena cava, and right atrium were constructed. On inserting the central vein catheters, the cavoatrial junction identified using the three-dimensional models were marked on the body surface, the tip was positioned at the corresponding location, and the actual insertion location was confirmed using a portable x-ray machine. The proposed method was evaluated by comparing the distance from the cavoatrial junction to the augmented reality location with that to the conventional location on x-ray. The mean distance between the cavoatrial junction and augmented reality location on x-ray was 1.2cm, which was significantly shorter than that between the cavoatrial junction and conventional location (1.9cm; P = 0.027). Central catheter insertion using augmented reality technology is more safe and accurate than that using conventional methods and can be performed at no additional cost in oncology patients.

Clinicoradiological Correlation of Covid19 Patients in Western Uttar Pradesh, India: A Descriptive Study

Abstract: A pilot study of 150 patients at premier medical institute of western Uttar Pradesh, INDIA. The purpose of this pictorial review article is to describe the most common manifestations and patterns of lung abnormality on CXR in COVID-19 in order to equip the medical community in its efforts to combat this pandemic. The varied spectra of COVID-19 presentation included fever, cough, shortness of breath, sore throat etc. Diabetes mellitus, hypertension, COPD/K-Chest and CAD were found as major comorbid conditions. Symptomatic presentation of COVID-19 was observed to be higher in patients with co morbid disease, especially if multiple. HRCT chest in COVID-19 patients had a major diagnostic and prognostic importance as positive CT findings were more prominent in symptomatic patients and co-morbid patients. Clinical symptoms of patients directly correlated with CT severity index. CT imaging was found to be useful in predicting clinical recovery of patients or progression of disease. Introduction: COVID-19 (coronavirus disease 2019) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), declared as a pandemic on 11th March 2020. The chest imaging findings are nonspecific and most commonly show atypical or organizing pneumonia, often with a bilateral, peripheral and bi-basal predominant distribution. Our study is concerned with the data of COVID positive patients admitted in the institute for the period of March 16- May 17, 2020. Aims and Objectives 1) To correlate clinical and radiological spectra of covid positive patients and their final outcome. 2) To describe the spectrum of lung parenchyma changes in the symptomatic as well as asymptomatic in COVID- 19 patients. Review of literature: This case report series presents a summary of key findings frequently associated with COVID-19, which will assist radiologists and clinicians in preliminary clinical evaluation (PCE). Materials and Methods: The data for the study is sourced from clinically suspected patients from the Covid Ward, LLRM Medical College, Meerut,(U.P.),INDIA which were subjected to chest radiography on 60mAh portable X-Ray machine. The patients are followed up to correlate the findings with clinical outcome. The study has been conducted on a minimum of 150 patients with portable Chest X-Ray machine. Observations & Discussion: The most frequent findings encountered are airspace opacities are viz- Hazy pulmonary opacities, Bilateral lower lobe consolidations, Peripheral air space opacities, Uncommon CXR findings, Diffuse air space disease. Conclusion: Based on our study, few inferences have been deduced; A significant proportion of the clinically symptomatic cases shows characteristic radiological changes on chest X-ray and also how chest radiography can be used as a tool not to substitute but supplement RTPCR in evaluation of COVID positive cases. Keywords: Patchy areas of consolidation, shortness of breath, high resolution CT Scan, RTPCR.