Radiographic Position Research Articles

An association between dimensions and bridging of the sella turcica and dental anomalies

Introduction The aim of this study was to determine the incidence of bridging of the sella turcica and the dimensions of the Sella in subjects with dental anomalies (transpositions, hypodontia, and supernumerary teeth) and to compare them to controls. Methodology Lateral cephalograms from 25 patients with dental transposition, 88 with hypodontia, and 26 with supernumerary teeth were evaluated. The shape, length, depth, diameter, and bridging of the Sella turcica were determined from radiographs and compared to those of control group (n=52). For statistical analysis, one-way ANOVA, Tukey post-hoc test, chi-squared test and T-test (to evaluate the influence of craniofacial growth) were used. Results The frequency of complete calcification of the Sella was greater in the group with supernumerary teeth (23%) and in the group with hypodontia (14.7%), while partial calcification of the Sella was more frequent in the control group (77%) and in the group with supernumerary teeth (73%)(p<0.05). The depth of the Sella was greater in the group with dental transposition. Oval and round Sella shapes were more frequent in all groups, and a flat Sella was rarely seen. In terms of the influence of growth on the dimensions of the Sella, there was no statistically significant difference between pre- and post-treatment radiographs. Conclusion Significant relationships were found between dental anomalies and bridging and shape of the Sella. The Sella was also significantly deeper in patients with dental transposition. The bridging and shape of the Sella may be useful in the diagnosis of dental anomalies in early childhood.

Students’ perceptions of setting up an augmented reality radiographic positioning simulation

Students’ perceptions of setting up an augmented reality radiographic positioning simulation

Anatomy of the paranasal sinuses of the common marmoset (Callithrix jacchus Linnaeus, 1758) and radiographic positioning for diagnosis of these structures

Callithrix jacchus, it is a species highly targeted by wild animal traffickers and, when apprehended, they need veterinary care. For safe therapeutic procedures, knowledge of anatomy is essential, as well as for diagnostic by imaging, good radiographic positioning is essential. The anatomy of the paranasal sinuses and the radiographic projections was described using 10 carcasses of common marmosets. Radiographs were taken in two panoramic views of their head: profile and frontal-naso. For the anatomical study, paramedian and transverse macroscopic sections and microscopic transverse sections were performed. On the radiographs, it was possible to identify the frontal recess and maxillary sinuses in profile and frontal-naso incidences. In the anatomical study, the frontal recess and maxillary, sphenoid and ethmoid paranasal sinuses were identified. The ethmoidal sinus could be observed only microscopically and the sphenoidal sinus difficult to see on the radiography due to the overlapping adjoining structures.

Localization of Mental Foramen in Panoramic Radiographs of 18-30 Year Olds: A Hospital Based Study

Background The position of the mental foramen demonstrates anatomical variations, although typically it is reported to be either between the apices of the first and second premolars or below the apex of the second premolar. Objective To determine the radiographic position of mental foramen in relation to Premolar crown and apex, in panoramic radiographs. Method Following ethical approval a retrospective study was conducted in 510 panoramic radiographs of 18-30 year olds from archives of Department of Oral Medicine and Radiology. The position of mental foramen was scored using crown and apex scores according to scoring criteria given by Jasser and Nwoku, 1998. Descriptive statistics was calculated and Chi-square test was applied to assess variation in position of mental foramen between genders and right and left side of mandible. Kappa statistics was applied to assess intra-observer reliability. Result The most common scoring for position of mental foramen on right side crown and apex was 3 (49.4%) followed by 4 (45.9%). Similarly, on left side the most common score for crown and apex was 3 (50.8%) followed by 4 (44.3%). There was no statistically significant difference in position between the genders. Comparing the right and left sides, the position was symmetrical in 83.3% for crown and apex scores. The Kappa values indicated good agreement for intraobserver reliability. Conclusion The most common position for the mental foramen is between the first and second premolar teeth; though, anatomical variations are seen.

Percutaneous Scaphoid Fixation: Experience Value among Different Approaches.

Background Percutaneous scaphoid osteosynthesis is an attractive and increasingly popular option, as a treatment for acute scaphoid fractures in selected cases, and as an alternative to conservative treatment. The purpose of this study is to assess the radiographic positioning of the screw in percutaneous scaphoid fixation, taking into consideration the surgeons' experience, and the difference between volar and dorsal approaches. Methods We retrospectively assessed patients undergoing percutaneous scaphoid fixation from 2013 to 2019. Inclusion criteria are as follows: (1) scaphoid waist fractures (Herbert's B2), (2) a minimum of 18 years of age and a maximum of 55 years of age, (3) dominant hand, (4) manual work, (5) minimum follow-up time of 6 months, and (6) without associated lesions. Criteria for correct positioning are as follows: (1) on the axis or parallel to the scaphoid axis with a maximum deviation of 1.5 mm volar/dorsal, (2) without proximal/dorsal prominence, (3) correct scaphoid alignment/reduction, and (4) absence of threads in the fracture site. Radiographs were evaluated separately by a hand surgeon, a general orthopaedic surgeon, and an orthopaedic resident. Results With a total of 39 patients, a dorsal approach was performed in 10 patients and a palmar approach in 29 patients. We verified a very good interobserver reliability. The hand surgeon's team correctly positioned 15 (83.3%, 15/18), while the other team did 9 correctly (42.9%, 9/21). Comparing teams according to the approach used, the dorsal approach did not show a statistical difference, while the same was not true for the volar approach ( p < 0.05). Conclusion This points to a positive impact on the team's experience in the positioning of the screws, and therefore in the benefit of treatment by teams dedicated to the area, while daring to suggest that less-experienced surgeons should utilize the dorsal approach.

Usefulness of 3-Dimensional Body Surface Scanning in the Evaluation of Patients with Pectus Carinatum.

BackgroundRadiographic modalities have been commonly used to evaluate pectus carinatum (PC), and compressive orthotic bracing is the most widely accepted treatment method. The aim of this study was to determine the efficacy of 3-dimensional (3D) body surface scanning as an alternative modality for the evaluation of PC.MethodsThe medical records of 63 patients with PC who were treated with compressive orthotic bracing therapy between July 2017 and February 2019 were retrospectively analyzed. Using both 2-view chest radiography (posteroanterior and lateral view) and 3D body scanning, the height of maximal protrusion of the chest wall was measured both before and after 2 weeks of bracing therapy. The difference between the pre- and post-treatment measurements was calculated for both modalities, and these differences were compared and analyzed.ResultsBased on the comparison between the pre- and post-treatment radiographs, bracing therapy produced favorable outcomes in all patients (p<0.001). The measurements obtained via 3D scanning were strongly correlated with those obtained via chest radiography (r=0.60).ConclusionBased on the findings of this study, 3D body surface scanning appears to be an effective, radiation-free, and simple method for the post-treatment follow-up evaluation of PC, and thus can be considered an alternative to radiography.

Changes in radiographic parameters following chiropractic treatment in 10 patients with adolescent idiopathic scoliosis: A retrospective chart review.

This retrospective chart review was undertaken to investigate the role of chiropractic intervention for patients with adolescent idiopathic scoliosis (AIS). Ten cases of patients with AIS, mean age 13.3 years, undergoing chiropractic adjustment were retrospectively evaluated. Chart review was performed to extract age, medical history and treatment intervention. The magnitude of scoliosis was quantified using the Cobb method on standing radiographs. A comparison of the measurements from pre- and post-treatment radiographs revealed that Cobb angle reduced from average 29.7° down to average 23.4° (average 21.2% correction). Improvements in spinal morphologies were observed in most curves (64%, n=9/14) and curve stabilization in the rest (36%, n=5/14). A better correction was obtained in cases of mild and moderate AIS. In terms of stabilizing progression (≤5o curve progression) or correcting curvatures (≥6° reduction), radiological changes were observed in all patients.

Progression of shallow medial femoral condyle radiographic lucencies in Thoroughbred repository radiographs and their influence on future racing careers.

Shallow lucencies less than 4mm deep into the medial femoral condyle (MFC) are frequent in Thoroughbred horses undergoing screening sales radiographs. It is unclear if these shallow defects are precursors to larger cystic lesions or if they are fully developed defects that remodel into a flattened femoral condyle. To evaluate radiological lucencies of the MFC and their progression in size, in a cohort of Thoroughbred horses, ranging from 5 to 18months of age and to report on the racing careers of these horses compared to their maternal siblings free of stifle pathology. Retrospective cohort. Radiographic reports were reviewed to identify cases with MFC lucency. Medical data including age at the time of radiographic sale set, sex, and MFC lucency radiographic measurements were recorded. The data were analysed for changes in lucency morphology. Racing data were collected and analysed for the following 5years. From 12938 sales reports reviewed, 3874 horses were found to have radiographic sets available at both weanling and yearling sales. A MFC lucency ≤3mm in depth was diagnosed in at least one radiographic sales set in 248 horses (6.4%). The right femur was more commonly affected (73.9%) than the left. Radiographic lucencies in the left femur were significantly smaller (P=.02) than lucencies in the right femur. Radiographic lucencies resolved in 6.1% of cases, 3.6% of cases developed into a cyst, 40.7% of cases were unchanged in size, 23.6% of lucencies decreased in size and 8.2% increased in size. Cysts >3mm deep regressed into smaller lesions accounting for 4.9% of the lucencies, and 12.9% of lucencies developed from a normal or flat medial femoral condyle contour. Horses with a medial femoral condyle lucency had significantly less starts as a 2-year-old vs. their maternal siblings (P<.01). Data were collected retrospectively. Measurement errors may have occurred due to the measuring tool scale, small size of the defects and/or radiographic position. Treatments between radiographic studies were unknown and could not be accounted for. Observers were not blinded to radiographic sales reports. Radiographically diagnosed lucencies in the MFC of immature Thoroughbreds have the potential to fully resolve or develop into a cyst. However, most radiographic lucencies do not change in size. Thoroughbreds with MFC lucencies had less starts as 2-year-olds when compared to their maternal siblings free of stifle pathology.

3D virtual reality simulation in radiography education: The students' experience

IntroductionSimulation forms a key element of undergraduate Radiography education as it enables students to develop their clinical skills in a safe environment. In this study, an immersive three-dimensional (3D) virtual radiography simulation tool was piloted in an undergraduate Radiography curriculum and user feedback retrieved. MethodsThe 3D virtual simulation tool by Virtual Medical Coaching Ltd was introduced to first year radiography students (n = 105). This technology guided students through a comprehensive process of learning anatomy, radiographic positioning and pathology. Students then X-rayed a virtual patient in the VR suite using HTC Vive Pro™ headsets and hand controllers. Instant feedback was provided. An online survey was later disseminated to students to gather user feedback. Thematic and descriptive statistical analyses were applied. ResultsA response rate of 79% (n = 83) was achieved. Most respondents (58%) reported enjoying VR simulation, whilst some felt indifferent towards it (27%). Ninety-four percent would recommend this tool to other students. The mean length of time it took for students to feel comfortable using the technology was 60 min (10–240 min). Most respondents (58%) desired more VR access. Students attributed enhanced confidence in the areas of beam collimation (75%), anatomical marker placement (63%), centring of the X-ray tube (64%) and exposure parameter selection (56%) to their VR practice. Many students (55%) advocated the use of VR in formative or low stakes assessments. Issues flagged included technical glitches, inability to palpate patient and lack of constructive feedback. ConclusionStudent feedback indicates that 3D virtual radiography simulation is a valuable pedagogical tool in radiography education Implications for practice3D immersive VR simulation is perceived by radiography students to be a valuable learning resource. VR needs to be strategically implemented into curricula to maximise its benefits.

The Clinical Utility of Additional Axillary and Velpeau Radiographs in the Evaluation of Suspected Shoulder Trauma.

To investigate the clinical utility of additional axillary or Velpeau views in evaluating potential shoulder trauma after a standard radiograph series of anteroposterior, Grashey, and/or trans-scapular views. Retrospective study. Level I academic medical center. All patients in a 10-year span who received an initial shoulder radiograph series followed by additional axillary/Velpeau views within 24 hours. The clinical utility of the additional axillary/Velpeau views, including the final diagnosis and treatment plan, as ascertained through examination of radiology reports, progress notes, and radiograph images. A total of 271 cases were reviewed, with 35 patients being excluded from the final cohort because they received post-treatment radiographs to confirm a successful therapeutic outcome. The additional axillary/Velpeau views did not affect clinical decision making in 230 (97.5%) of the remaining 236 cases. All 6 patients whose care benefitted from the additional views carried the diagnosis of shoulder instability, accounting for 40% of this diagnostic group. The additional views confirmed an equivocal finding in 5 of these 6 cases and changed the diagnosis (demonstrating a posterior dislocation that was not evident on initial radiographs) and treatment plan (leading to a closed glenohumeral reduction procedure) in the other case. Additional axillary/Velpeau views of suspected shoulder trauma rarely led to a change in the final treatment plan, except in patients in which a definitive diagnosis of stability or instability could not be made based on initial radiographs. A cost/benefit analysis is required to weigh the cost of additional radiographs with the benefit of capturing infrequent yet serious dislocations (usually posterior). Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Variability in stable sagittal vertebra (SSV) during full-length biplanar xrays can affect the choice of fusion levels in patients with adolescent idiopathic scoliosis (AIS).

Surgical planning for Adolescent Idiopathic Scoliosis (AIS) relies on the coronal and sagittal plane to determine the lowest instrumented vertebra (LIV). Failure to include the stable sagittal vertebra (SSV) within the construct can increase the incidence of postoperative distal junctional kyphosis (DJK). The purpose of this study is to assess the variability of SSV within patients and to identify positional parameters that may lead to its change. This is a case-control study of AIS patients with changes in SSV throughout serial radiographs. Radiographic sagittal parameters and hand positioning for the patients with changes in SSV were compared to patients with stable SSV. Additionally, a subgroup analysis was conducted to compare the positional parameters of only the patients with changes in SSV. 46 patients with a mean age of 15 ± 1.8years old at the time of surgery were included in this study. 33/76 (43.4%) image pairs were found to have a change in SSV. Positional parameters associated with the more distally measured SSV were found to have a more negative sagittal vertebral axis (p = 0.001), more positive pelvic shift (p = 0.023), and more negative Global Sagittal Axis (p = 0.001) when compared to the more proximally measured SSV. Significant variability exists in the determination of SSV in AIS patients undergoing serial radiographs. Positional parameters associated with the proximal and distally measured SSV also have variability which indicates that posture has a significant impact on this measure. Surgeons need to be aware of SSV variability during preoperative planning and must consider multiple parameters for the determination of LIV. 3.

The Influence of Sagittal Proximal Tibial Anatomy in Tibial Intramedullary Nailing

To quantify anatomic variation in sagittal proximal tibial anatomy and determine if anatomy or nail insertion method influences radiographic nail position. Retrospective cohort of prospectively collected data SETTING:: Level 1 trauma center. 45 patients with 46 tibia fractures (OTA/AO 41A, 42, and 43) treated with infrapatellar (IP) or suprapatellar (SP) nailing. The average patient age was 40.6 years (range 19-62 years). Patients received IP or SP nailing. Cohorts were analyzed based on nailing technique as well as proximal tibial anatomy. Proximal tibial radiographic anatomy was quantified using novel measurements (anterior tubercle angle [ATA], entry point position [EPP]). Nail entry point, entry point displacement after reaming, nail position, and quality of reduction was measured and compared between groups. ATA was highly variable between patients. ATA was strongly correlated with EPP with a higher ATA associated with EPP more co-linear with the intramedullary canal. Patients with low ATA treated with IP nailing had significantly longer operative times (60.0 vs 45.7 minutes). Low ATA tibias had a higher incidence of entry point displacement due to eccentric reaming compared to high ATA tibias (70% vs 38%) with the highest incidence of entry point displacement and absolute displacement in low ATA tibias treated with IP nailing (86%, 2.8mm). SP nailing demonstrated shorter operative times relative to IP nailing (45.5 vs 55.6 minutes). There is considerable variability in proximal tibial anatomy and these features influences nail position within the tibia. These differences in anatomy should be considered to potentially reduce operative times, entry point displacement and anteriorization of tibial nails. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Reliability of the radiographic views in supine position for evaluation of displaced midshaft clavicle fracture length.

To analyze the agreement of the displaced midshaft clavicle fracture length measurement between each of the supine radiographic position (chest anteroposterior (AP), both clavicle AP, and 20° cephalic tilt clavicle AP view) and computed tomography (CT) scan of the clavicle. Furthermore, the inter- and intraobserver reliability of each radiographic position was analyzed. Prospective cross-sectional study was performed with patients diagnosed with displaced midshaft clavicle fracture treated conservatively. Three views of radiographs and CT scan of clavicle were obtained in supine position after informed consent. The measurement of fractured clavicle length was done by three observers at the time and after 4 weeks interval. Thirty-three patients (25 males and 8 females), with a mean age of 45, were recruited. The agreement between each of the radiographic measurement and CT scan was good. The interobserver reliability was moderate to good for radiographic measurement. The highest intraclass correlation coefficient (ICC) of 0.80-0.81 was shown between the 20° cephalic tilt and the CT scan, followed by the both clavicle AP (0.75-0.77) and the chest AP (0.69-0.75), respectively. There was an excellent intraobserver reliability for all of the radiographic measurement with the ICC 0.92-0.99. The supine radiographs could be a useful option to measure the displaced midshaft clavicle fracture length. The recommended view was the 20° cephalic tilt clavicle AP view in supine position to best evaluate the fractured clavicle length.

Comparison of Root Resorption in Endodontically and Non-Endodontically Treated Teeth in Patients with Fixed Orthodontic Treatment during 2009-2018

Introduction: Apical root Resorption is a common occurrence during fixed orthodontic treatment. This study used panoramic radiographs to compare the rate of root resorption in endodontically-treated and non-endodontically-treated roots. Methods: In this descriptive-analytic study, panoramic radiographs of 20 patients aged 11-18 years with Class I Crowding and Class II Mild Skeletal malocclusions and with one or more endodontically-treated maxillary anterior teeth in one side and corresponding non-endodontically-treated teeth on the other side of the jaw were selected. They had presented to Dental School of Shahid Sadoughi University of Medical Sciences and private dental offices in Yazd. All panoramic radiographs of central and lateral maxillary incisors obtained before and after treatment were scanned and displayed on a large monitor with X2 magnification. In this way, the real magnitude of root degeneration was estimated by comparing the root heights in the pre- and post-treatment radiographs. The data were analyzed by SPSS 22 and T-test. Results: The findings showed that the greatest rate of root resorption was observed in the upper maxillary lateral incisors of endodontically-treated teeth by 1 mm and in maxillary lateral incisors of the non-endodontically-treated teeth by 1.5 mm. The mean root resorption was 0.325 mm in the endodontically-treated teeth and 1.025 mm in the non-endodontically treated teeth with a statistically significant difference (P&gt;0.001). Conclusion: The results demonstrated that root resorption was smaller after treatment in endodontically-treated teeth than non-endodontically-treated teeth.

Root canal treatment of mandibular second premolars with three root canals: Report of four rare cases

Background/Aim: The aim of root canal treatment is the thorough cleaning, shaping and obturation of the root canals. Variations in root canal anatomy increase the difficulty of the root canal treatment and therefore the possibility of failure. The mandibular premolars often present complex anatomy and the existence of mandibular second premolars with three root canals is very scarce. This report presents the successful endodontic management of four mandibular second premolars with three root canals. Cases Report: In all cases working length was estimated using the working length radiograph and an apex locator. Canal orifices were enlarged with Gates-Glidden drills and manual instrumentation performed with Stainless Steel reamers and Hedstroem files, using either step-back or crown-down technique. Sodium hypochlorite (NaOCl) 2.5% was used as an irrigant. Root canal obturation were then performed using the cold lateral condensation technique with gutta-percha points and Roth's 801 canal sealer. The cases were scheduled for clinical and radiographic follow-up examination. Clinically in all follow-up examinations the teeth were asymptomatic. For the three cases with periapical lesions, post treatment radiographs, demonstrated periapical healing. Additionally, in the case without periapical lesion, the 9 months recall radiograph revealed healthy periapical conditions. Conclusions: Mandibular premolars should never be underestimated and the clinician should always be alerted for anatomic variations.

Perceptual training: learning versus attentional shift.

Prior research has demonstrated that perceptual training can improve the ability of healthcare trainees in identifying abnormalities on medical images, but it is unclear if the improved performance is due to learning or attentional shift-the diversion of perceptional resources away from other activities to a specified task. Our objective is to determine if research subject performance in perceiving the central venous catheter position on radiographs is improved after perceptional training and if improved performance is due to learning or an attentional shift. Forty-one physician assistant students were educated on the appropriate radiographic position of central venous catheters and then asked to evaluate the catheter position in two sets of radiographic cases. The experimental group was provided perceptional training between case sets one and two. The control group was not. Participants were asked to characterize central venous catheters for appropriate positioning (task of interest) and to assess radiographs for cardiomegaly (our marker for attentional shift). Our results demonstrated increased confidence in localization in the experimental group ( -value ) but not in the control group ( ). The ability of subjects to locate the catheter tip significantly improved in both control and experimental groups. Both the experimental ( ) and control groups ( ) demonstrated equivalent decreased performance in assessing cardiomegaly; the difference between groups was not significant ( ). This suggests the performance improvement was secondary to learning not due to an attentional shift.

Discrepancy between radiographic and true cup position after total hip arthroplasty : Are we interpreting our radiographic quality indicators correctly? Video article

After total hip arthroplasty (THA), objective postoperative quality control is done via X‑rays by as component position assessment. The cup position is defined by its version and inclination. However, there is adiscrepancy between radiographically measured and true (anatomic) cup position, which may lead to misinterpretation. To visualize the discrepancy between true and radiographically measured cup position, in this video, acup holder was used to set the angular cup version and inclination. Hereby, the cup position (anteversion and inclination) can be characterized in its radiographic and anatomic definition in greater detail. The viewer of this video should receive an impression as to when radiographically measured cup angles must be considered with caution. In asimultaneous X‑ray and image sequence, this video shows decreased radiographic inclination measurement with increasing anterior rotation of the cup exceeding 20° of anteversion, yet with unchanged true inclination on the cup holder. Isolated consideration of the radiographic angles of anteversion and inclination may cause misinterpretation of true cup position. In pectoral illustration we show that variations in cup version and inclination may remain undetected when considering isolated the radiographic cup parameters. True cup position in its anatomical definition can be calculated from the radiographically measured position. For this purpose, both cup parameters (radiographic anteversion and radiographic inclination) have to be taken into account.

Influence of Anesthesia on Grading of Canine Hip Dysplasia

This study aimed to evaluate the effect of anesthesia on grading of canine hip dysplasia. For this purpose, 20 middle-sized healthy dogs from different breeds were used. Radiographs were taken using 4 different imaging methods, including the hip-extended, subluxation, distraction, and compression. This procedure was repeated 4 times for each dog, while the dogs were unanesthetized and anesthetized with 3 different anesthetic protocols at 15-day intervals (propofol [5 mg/kg, IV]; diazepam [0.5 mg/kg, IV] / ketamine [20 mg/kg, IV]; medetomidine [0.05 μg/kg, IM] / ketamine [20 mg/kg, IM]). The radiographs were taken and evaluated by the same investigator to prevent interobserver variation. Because of the radiographic positioning difficulty, unanesthetized radiographic imaging revealed higher repetition number than the anesthetized; therefore, radiation safety decreased. The administration of diazepam/ketamine and medetomidine/ketamine was sufficient in terms of both muscle relaxation and duration of the anesthesia; however, some dogs under propofol anesthesia were required maintenance doses to complete radiographic imaging procedure. Unanesthetized radiographic images of the dogs had significantly lower (P < .001) hip score, distraction index (DI), subluxation index (SI), and higher compression index (CI) (P< .001), when compared with anesthetized radiographic images. When compared the anesthetic protocols, propofol revealed lower (P< 0.001) hip score, DI, SI, and higher (P < .001) CI than medetomidine/ketamine. Medetomidine/ketamine is the most appropriate anesthetic protocol for detailed radiographic evaluation of CHD considering both muscle relaxation and duration of action.

Virtual reality versus conventional clinical role-play for radiographic positioning training: A students' perception study

IntroductionSimulated learning environments (SLEs) are commonly utilised by educational institutions. The aim of this study was to assess if students perceptions varied relating to the effectiveness of either a virtual reality (VR) simulation or traditional clinical role-play scenario in developing radiographic hand positioning skills. MethodsA split-cohort study was performed with Year 1 Undergraduate Radiography students (n = 76). Students were randomly assigned to undertake training for radiographic hand positioning tasks using either the CETSOL VR Clinic software (Group 1) or traditional clinical role-play (Group 2). Following completion of their positioning training, students’ perceived impact of the SLE on developing practical and technical skills were assessed using a 5-point Likert scale questionnaire and free text option. ResultsQuantitative student perception scores indicated no significant difference between the two simulation modalities, the mean agreement scores (combined strongly agree + agree) for Groups 1 and 2 were 74.8% and 83.8%, respectively, where χ2 (4, n = 66) = 9.5, p-value = 0.394. Key themes expressed by students following a thematic analysis were “engagement with the learning environment, positioning practice and comparability to clinical practice. ConclusionThe perceptions of novice students in training for radiographic hand positioning tasks, using either a VR SLE or clinical role-play scenario, did not differ. There was a strong similarity in common themes, however, a key point of difference identified was the benefit of repetition afforded by the VR simulation, in contrast to the need for more time using traditional role-play in a constrained laboratory setting. Implications for practiceThe lack of difference in student perceptions between VR and clinical role-play training, could offer a different approach to clinical training which is easily accessible and allows users to correct mistakes at their own pace.

Techniques d’alignement cinématique versus conventionnel des prothèses totales de hanche : étude cas témoin

BackgroundResidual complications of conventionally implanted hip components have only been partially reduced by improved implant design and higher surgical precision, and their occurrence is poorly predicted by the radiographic standing/supine cup orientation. This has raised awareness that conventional techniques may not aim for the correct component orientation target, and the lumbo-pelvic kinematics, which influence the functional acetabular orientation, may be of interest to further improve THA clinical outcomes. This has led to the development of the Lumbo-Pelvic kinematic alignment (KA) technique for THA that aims to anatomically position and kinematically align hip implants (acetabular and femoral, total and resurfacing components), in order to optimise prosthetic hip biomechanics and hopefully improve prosthetic function, patient satisfaction, and components’ lifespan. Therefore, we conducted a case control investigation to assess the early-term safety and efficacy of this new technique by answering the following questions: does the KA technique for THA: (1) better restore the native hip anatomy, (2) generate a different radiographic supine cup position, and (3) improve clinical outcomes in comparison to the conventional mechanical alignment technique? HypothesesUsing KA technique allows there is no statistically significant difference between the pre to postoperative differential for acetabular medial and vertical offsets, femoral offset, and leg length. MethodsWe led a case-control retrospective study with prospectively collected clinical data. Forty-one consecutive unselected KA-THAs performed with manual instrumentation were paired with 41 mechanically aligned THAs. The 1-year clinical outcomes and radiographical measurements were compared. ResultsCompared to the mechanical alignment technique, the KA technique resulted in a more anatomical restoration of the prosthetic hip centre of rotation with a lower delta pre- to post-operative horizontal acetabular offset (1.47mm for KA vs. −5.1mm for MA, p=0.001), and with 74% of KA vs. 50% of MA cups (p=0.044) being within 15% of native anatomy for the horizontal acetabular offset. In addition, the KA technique resulted in a higher cup anteversion (22̊±7̊ vs. 15̊±8̊, p<0.001) but similar cup inclination (41̊±6̊ vs. 42̊±7̊, p=0.25), a similar proportion of cups within the Lewinnek zone (65% vs. 70%, p=0.8), similar excellent functional outcomes (delta Oxford score pre- to follow-up of 24.3 and 23.5 points for KA and MA groups, respectively, p=0.88), similar patient satisfaction scores of 95.4/100 and 89.5/100 for KA and MA groups, respectively, and the same absence of aseptic complications. ConclusionThe KA technique for THA has been demonstrated to be safe, efficacious, and not inferior to the conventional MA technique at early-term. As the concept of the KA technique for THA is only at an early stage, its influence on mid to long-term clinical outcomes remains to be determined and further refinements of the concept are yet to be made. Level of evidenceIII; case-control retrospective study.