Anterior-posterior View Research Articles

Anterior-Posterior View Acquisition During Videofluoroscopy: A Survey Study Exploring Influential Factors on Speech-Language Pathologists' Practice Patterns.

This study explored factors influencing speech-language pathologists' (SLPs') decision making surrounding anterior-posterior (AP) view inclusion practices during videofluoroscopic swallowing studies (VFSSs) in the United States. SLPs completing VFSSs were recruited to complete an online anonymous survey. Questions represented six constructs of interest including: (a) clinician demographics, (b) practice patterns, (c) diagnostic perceptions, (d) professional influences, (e) training and education, and (f) logistical facilitators and barriers. Binary logistic regression was used to explore the relationship between construct items and likelihood of AP view inclusion. A total of 136/213 (64%) of respondents reported obtaining an AP view routinely. Facilitators of AP view inclusion were post-acute work setting (OR = 3.40, p = .001); perception that department practices "probably" (OR = 5.65, p = .006) or "definitely" align (OR = 5.30, p = .006) with evidence-based practice; perception the AP view has "a lot" (OR = 4.17, p = .025) or "a great deal" (OR = 4.77, p = .028) of diagnostic value; perception that their department is "definitely" supportive (OR = 4.69, p = .040); "moderate" (OR = 4.75, p = .001) or "no" (OR = 7.51, p < .001) equipment limitations; and radiologist support greater than "extremely unsupportive or resistant" ("somewhat unsupportive" [OR = 5.74, p = .041], "neutral" [OR = 11.23, p = .002], "somewhat supportive" [OR = 13.92, p = .001], or "extremely supportive" [OR = 13.92, p = .001]). Barriers to AP view inclusion were geographic location in the southern U.S. census region (OR = 0.31, p = .007), being "significantly" influenced by coworker opinions (OR = 0.13, p = .018), and productivity tracking (OR = 0.21, p = .008). Environmental factors and organizational culture heavily influence AP view inclusion practices.

The Detection and Classification of Scaphoid Fractures in Radiograph by Using a Convolutional Neural Network.

Scaphoid fractures, particularly occult and non-displaced fractures, are difficult to detect using traditional X-ray methods because of their subtle appearance and variability in bone density. This study proposes a two-stage CNN approach to detect and classify scaphoid fractures using anterior-posterior (AP) and lateral (LA) X-ray views for more accurate diagnosis. This study emphasizes the use of multi-view X-ray images (AP and LA views) to improve fracture detection and classification. The multi-view fusion module helps integrate information from both views to enhance detection accuracy, particularly for occult fractures that may not be visible in a single view. The proposed method includes two stages, which are stage 1: detect the scaphoid bone using Faster RCNN and a Feature Pyramid Network (FPN) for region proposal and small object detection. The detection accuracy for scaphoid localization is 100%, with Intersection over Union (IoU) scores of 0.8662 for AP views and 0.8478 for LA views. And stage 2: perform fracture classification using a ResNet backbone and FPN combined with a multi-view fusion module to combine features from both AP and LA views. This stage achieves a classification accuracy of 89.94%, recall of 87.33%, and precision of 90.36%. The proposed model performs well in both scaphoid bone detection and fracture classification. The multi-view fusion approach significantly improves recall and accuracy in detecting fractures compared to single-view approaches. In scaphoid detection, both AP and LA views achieved 100% detection accuracy. In fracture detection, using multi-view fusion, the accuracy for AP views reached 87.16%, and for LA views, it reached 83.83%. The multi-view fusion model effectively improves the detection of scaphoid fractures, particularly in cases of occult and non-displaced fractures. The model provides a reliable, automated approach to assist clinicians in detecting and diagnosing scaphoid fractures more efficiently.

Predicting Functional Outcome After Nonoperative Treatment of Proximal Humeral Fractures Involving the Surgical Neck

BackgroundIn nonoperative treated proximal humeral fractures (PHF), uncertainty remains regarding functional outcome. Therefore, the aim was to identify predictors of functional outcome following nonoperative treatment of PHF and to develop predictive models. MethodsAdults with a nonoperatively treated PHF involving the surgical neck were followed for 1 year. Radiographic parameters included fracture configuration, displacement, bone quality, and the critical shoulder angle (CSA). The neck-shaft angle (NSA) and humeral head offset assessed displacement. The greater tuberosity index (GTI) addressed greater tuberosity (GT) displacement relative to the articular surface while the impingement index addressed GT-displacement relative to the acromion. Multivariate regression models determined predictors of impaired function as measured by Constant Score (CS), flexion, and external rotation (ER). Recursive partitioning created a decision tree model over dichotomized functional outcome that combined flexion and ER (good = flexion ≥ 120° and ER ≥ 40°). ResultsIn 272 consecutive patients (mean age: 66 years, 69% women and 31% men), mean functional outcomes were a CS of 74 points, 138° flexion, and 50° ER. Older age was a predictor for impaired CS, flexion, and ER (p < 0.001), while sex only influenced CS (p = 0.040). Every 10% increase in GTI assessed on the Y-view explained a decrease of 3 CS points, 7° of flexion, and 5° of ER (p < 0.001). Every 10° of varus angulation assessed on anterior-posterior (ap) views in internal rotation resulted in a decrease of 1 CS point and 4° of flexion (p ≤ 0.004). Subgroups of combined important GT-displacement (GTI ≥ 1.15) with age > 76 years or < 119° varus angulation demonstrated the worst function. Linear prediction models estimated flexion, ER, and CS with a mean difference of 10°, 3°, and 3 points, respectively. The decision tree model predicted good function with 80% accuracy (positive predictive value = 81%; negative predictive value = 78%). ConclusionDemographic and radiographic predictors were identified allowing for accurate functional prognosis of nonoperatively treated PHF involving the surgical neck. A combined assessment of the ap-view in internal rotation and Y-view is sufficient for accurate function prediction. The identified subgroups resulting in good or impaired function, and the predictive models may be useful for patient counseling and guidance of treatment-related expectations.

Artificial intelligence in traumatology.

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

A retrospective study on ABO Blood Groups and Chronic Obstructive Pulmonary Diseases.

Objective: To investigate the potential association between ABO blood groups and the incidence of chronic obstructive pulmonary disease (COPD) in a population from Hyderabad, Pakistan.Methodology: This was a retrospective comparative type of study conducted in the pulmonology OPD (Out Patient Department) of the Liaquat University Hospital Hyderabad from June 2023 to September 2023. Five hundred and thirty (n =530) patients who visited pulmonology OPD were selected. Three hundred male and 230 female patients who visited the Pulmonology OPD for different respiratory illnesses were included in this study. COPD was diagnosed by the historyof illness and x-ray chest posterior-anterior (P/A) view. Blood groups were determined by the blood agglutination method.Results: The results show that most COPD male patients (13.20%) contain the O group, 8.45% have the A group, 5.66% have the B group, and 0.56% have the AB group. The P value was &gt; 0.05, which was relatively higher in the O group patient when Fischer’s exact test was applied.Conclusion: The study concludes that there was a potential association between ABO blood group O and an increased risk of chronic obstructive pulmonary disease (COPD), warranting further research to confirm these findings. Key words: Blood group, chronic obstructive pulmonary disease, Rhesus group, Hyderabad, Pakistan.

DSA Quantitative Analysis and Predictive Modeling of Obliteration in Cerebral AVM following Stereotactic Radiosurgery.

Stereotactic radiosurgery is a key treatment modality for cerebral AVMs, particularly for small lesions and those located in eloquent brain regions. Predicting obliteration remains challenging due to evolving treatment paradigms and complex AVM presentations. With digital subtraction angiography (DSA) being the gold standard for outcome evaluation, radiomic approaches offer potential for more objective and detailed analysis. We aimed to develop machine learning modeling using DSA quantitative features for post-SRS obliteration prediction. A prospective registry of patients with cerebral AVMs was screened to include patients with digital prestereotactic radiosurgery DSA. Anterior-posterior and lateral views were retrieved and manually segmented. Quantitative features were computed from the lesion ROI. Following feature selection, machine learning models were developed to predict unsuccessful 2-year total obliteration using processed radiomics features in comparison with clinical and radiosurgical features. When we evaluated through area under the receiver operating characteristic curve (AUROC), accuracy, area under the precision-recall curve F1, recall, and precision, the best performing model predictions on the test set were interpreted using the Shapley additive explanations approach. DSA images of 100 included patients were retrieved and analyzed. The best-performing clinical radiosurgical model was a gradient boosting classifier with an AUROC of 68% and a recall of 67%. When we used radiomics variables as input, the AdaBoost classifier had the best evaluation metrics with an AUROC of 79% and a recall of 75%. The most important clinico-radiosurgical features, ranked by model contribution, were lesion volume, patient age, treatment dose rate, the presence of seizure at presentation, and prior resection. The most important ranked radiomics features were the following: gray-level size zone matrix, gray-level nonuniformity, kurtosis, sphericity, skewness, and gray-level dependence matrix dependence nonuniformity. The combination of radiomics with machine learning is a promising approach for predicting cerebral AVM obliteration status following stereotactic radiosurgery. DSA could enhance prognostication of stereotactic radiosurgery-treated AVMs due to its high spatial resolution. Model interpretation is essential for building transparent models and establishing clinically valid radiomic signatures.

Timing of Surgical Treatment for High-Grade Acromioclavicular Joint Injuries Does Not Affect Functional Outcomes

PurposeTo determine whether patient-reported outcomes are associated with surgical timing utilizing a multivariate regression. MethodsAC joint surgery patients from 2010-2019 were included if they underwent primary AC joint surgery for a Rockwood grade III-V AC joint separation. Chart review was conducted to determine time from injury to surgery, Rockwood injury grade, and surgical technique. Post-operative complications, revisions, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) scores, and radiographic outcomes were collected. Radiographic outcomes were determined by measuring coracoclavicular (CC) distance on preoperative, immediate postoperative, and all follow-up anterior-posterior views of the operative shoulder. Multivariate regressions were conducted with post-operative ASES, SANE, and CC distance as the outcomes of interest. ResultsOverall, 221 patients (104 early, 117 delayed) with an average age of 40±15 years were included in this study. Significant differences in patient age, BMI, injury grade, surgical technique utilized, and pre-operative CC distance were observed between groups (all p<0.05). After controlling for confounding variables such as age, sex, BMI, injury grade, and surgical technique, multivariate regression found that time from injury to surgery was not related to post-operative ASES score (R2=0.137, p=0.563) or post-operative SANE score (R2=0.087, p=0.441). Female patients had lower ASES scores than male patients (estimate: -8.25, 95% CI: -15.99 to -0.050, p=0.039), however no other significant relationships were identified from multivariate regression. ConclusionTiming of AC joint surgery did not affect functional outcomes. Clinicians may counsel patients that either early or delayed surgery may be appropriate. Level of EvidenceIII (retrospective cohort study)

Comparative analysis of contrast distribution in cervical epidural steroid injections utilizing a modified paramedian interlaminar approach with varied needle tip positions: A randomized controlledtrial.

Recent advancements in cervical interlaminar epidural steroid injections have given rise to the modified paramedian interlaminar (mPIL) approach. The objective of this study was to perform an analysis of the contrast spread pattern within the cervical epidural space, taking into account different needle tip positions in the mPIL approach. A total of 48 patients were included in the study and randomly assigned to either the medial or lateral group based on the needle tip's position in the anterior-posterior view. The primary outcome measured was the contrast flow under fluoroscopic visualization. As a secondary outcome, we analyzed the location of the needle tip position in both lateral and contralateral oblique views. Clinical effectiveness was assessed by measuring pain intensity and functional disability post-procedure. Significant disparities were noted in the ventral distribution of contrast between the medial and lateral groups. In the lateral images, needle tips in the lateral group were positioned more ventrally compared to those in the medial group. Both groups exhibited statistically significant improvements in neck and radicular pain, as well as functional status, 4 weeks after treatment, with no significant differences between them. Our results suggest that the ventral dispersion of contrast material during cervical interlaminar epidural steroid injections using the mPIL approach may vary depending on the needle tip location.

AFFnet - a deep convolutional neural network for the detection of atypical femur fractures from anteriorposterior radiographs

Despite well-defined criteria for radiographic diagnosis of atypical femur fractures (AFFs), missed and delayed diagnosis is common. An AFF diagnostic software could provide timely AFF detection to prevent progression of incomplete or development of contralateral AFFs. In this study, we investigated the ability for an artificial intelligence (AI)-based application, using deep learning models (DLMs), particularly convolutional neural networks (CNNs), to detect AFFs from femoral radiographs. A labelled Australian dataset of pre-operative complete AFF (cAFF), incomplete AFF (iAFF), typical femoral shaft fracture (TFF), and non-fractured femoral (NFF) X-ray images in anterior-posterior view were used for training (N = 213, 49, 394, 1359, respectively). An AFFnet model was developed using a pretrained (ImageNet dataset) ResNet-50 backbone, and a novel Box Attention Guide (BAG) module to guide the model's scanning patterns to enhance its learning. All images were used to train and internally test the model using a 5-fold cross validation approach, and further validated by an external dataset. External validation of the model's performance was conducted on a Sweden dataset comprising 733 TFF and 290 AFF images. Precision, sensitivity, specificity, F1-score and AUC were measured and compared between AFFnet and a global approach with ResNet-50. Excellent diagnostic performance was recorded in both models (all AUC >0.97), however AFFnet recorded lower number of prediction errors, and improved sensitivity, F1-score and precision compared to ResNet-50 in both internal and external testing. Sensitivity in the detection of iAFF was higher for AFFnet than ResNet-50 (82 % vs 56 %). In conclusion, AFFnet achieved excellent diagnostic performance on internal and external validation, which was superior to a pre-existing model. Accurate AI-based AFF diagnostic software has the potential to improve AFF diagnosis, reduce radiologist error, and allow urgent intervention, thus improving patient outcomes.

Osteosarcoma associated with cemento-osseous dysplasia: co-incidence or two related entities?

BackgroundOsteosarcoma of the jaws is a rare primary malignant tumor of bone. The clinical, radiological and histopathological features of a case associated with cemento-osseous dysplasia is presented.Case ReportA 57-year-old mixed-race female presented with a large, progressive, swelling of the right mandible. Radiographic examination revealed two associated lesions. Partially defined irregular radiopacities were noted in the left mandible, extending from the premolar to the molar region. The lesion had a cotton-wool appearance and resembled a fibro-osseous lesion; i.e. cemento-osseous dysplasia. A second large, expansive and irregular, radiopaque lesion was noted on the right angle of the mandible, extending beyond the inferior cortex of the mandible. The internal structure was heterogeneous and resembled irregular bone formation. The classic “sunburst” appearance of radiating bony spicules can be seen in the posterior–anterior view and the CBCT 3D reconstruction, indicating the outgrowth of the tumor matrix. Histopathological exam confirmed a final diagnosis of osteosarcoma closely associated with cemento-osseous dysplasia. The patient underwent a fludeoxyglucose-18 (FDG) positron emission tomography (PET) scan which indicated metastasis in the left lung and increased uptake in the right mandible. Chemotherapy was initially administered with a plan to resect the tumor, however, the patient demised as a result of medical complications.ConclusionThe question in the literature remains whether these two entities are coincidentally found or arise from each other. Nevertheless, it is important for clinicians to closely monitor patients with cemento-osseous dysplasia and biopsy any suspicious lesions that may develop into osteosarcoma.

Femoral Head Fractures: Conservative or Surgical Treatment? About 2 Cases

Femoral head fractures are uncommon and invariably occur alongside hip dislocation. High-energy trauma is the sole cause, and diagnosis can be missed using only standard pelvic radiographs (anterior-posterior, lateral, ¾ alar and obturator views), a CT scan is often recommended for a precise diagnosis. Treating dislocated hips with femoral head parcelar fractures is challenging. This difficulty arises from selecting both the surgical approach and the management of the fracture fragments. Additionally, the risk of osteonecrosis and osteoarthritis compromises the long-term function of the hip. We report two cases of femoral head fracture associated with hip dislocation. The first was received surgical treatment, while the second was managed conservatively.

Miliary Tuberculosis in In Vitro Fertilization pregnancy: a series of three cases with a history of hypothyroidism

In Vitro Fertilization (IVF) pregnancy is associated with a higher risk of tuberculosis as compared to normal pregnancy. This increased risk remains unexplained. Most of the reports are based on small case series, and the risk profile is not well described. Hypothyroidism has not been described as a potential risk factor in any series. In this case series, we elaborate on the profile of three military tuberculosis cases of IVF pregnancies, all having hypothyroidism history as the common factor, and were referred to our super-specialty center with the onset of symptoms during the late first or mid-second trimester of pregnancy. All three cases were diagnosed on X-ray chest Posterior-Anterior (PA) view, showing miliary tuberculosis and a known case of hypothyroidism. Antitubercular treatment was started. In this report, we describe the clinical course and unfavorable outcomes of these three cases.

Role of Critical Shoulder Angle in Degenerative Type Rotator Cuff Tears: A Turkish Cohort Study.

BACKGROUND This retrospective study investigated the association between the critical shoulder angle (CSA) and the development of full-thickness rotator cuff tears (FTRCTs) in the Turkish population. The CSA is an imaging parameter that quantifies the relationship between the inclination of the glenoid and the lateral extension of the acromion in the coronal plane. The CSA is an anatomical measurement, and higher CSA values have been associated with an increased incidence of FTRCTs. However, there is a lack of data on CSA regarding the Turkish population. MATERIAL AND METHODS In this study, CSA measurements were recorded in 2 groups: 50 patients with FTRCT who had arthroscopic repair (group 1) and 50 age- and sex-matched individuals with no FTRCT detected by magnetic resonance imaging (group 2). Sex, age, affected side, dominant side, and smoking status were recorded for each patient. The CSA measurements of the affected sides were performed on true anterior-posterior view radiographs. RESULTS The results showed a statistically significant difference between the mean CSA values of group 1 (37.48°) and group 2 (33.53°), P<0.001. CSA values of 36 and above had a sensitivity of 73.58%, specificity of 74.47%, positive predictive value of 75%, and negative predictive value of 74.47% for detecting FTRCT. CONCLUSIONS CSA measurement on radiographs is a useful diagnostic tool in the Turkish population, and an above-average CSA value is associated with a significantly increased incidence of degenerative-type FTRCT.

Novel Screw Placement Method for Extremely Small Lumbar Pedicles in Scoliosis.

Study Design: Consecutive case series. Objective: To propose a screw placement method in patients with extremely small lumbar pedicles (ESLPs) (<2 mm) to maintain screw density and correction power, without relying on the O-arm navigation system. Summary of Background Data: In scoliosis surgery, ESLPs can hinder probe passage, resulting in exclusion or substitution of the pedicle screws with a hook. Screw density affects correction power, making it necessary to maximize the number of screw placements, especially in the lumbar curve. Limited studies provide technical guidelines for screw placement in patients with ESLPs, independent of the O-arm navigation system. Methods: We enrolled 19 patients who underwent scoliosis correction surgery using our novel screw placement method for ESLPs. Clinical, radiological, and surgical parameters were assessed. After posterior exposure of the spine, the C-arm fluoroscope was rotated to obtain a true posterior-anterior view and both pedicles were symmetrically visualized. An imaginary pedicle outline was presumed based on the elliptical or linear shadow from the pedicle. The screw entry point was established at a 2 (or 10) o'clock position in the presumed pedicle outline. After adjusting the gear-shift convergence, both cortices of the transverse process were penetrated and the tip was advanced towards the lateral vertebral body wall, where an extrapedicular screw was placed with tricortical fixation. Results: Out of 90 lumbar screws in 19 patients, 33 screws were inserted using our novel method, without correction loss or complications during an average follow-up period of 28.44 months, except radiological loosening of one screw. Conclusions: Our new extrapedicular screw placement method into the vertebral body provides an easy, accurate, and safe alternative for scoliosis patients with ESLPs without relying on the O-arm navigation system. Surgeons must consider utilizing this method to enhance correction power in scoliosis surgery, regardless of the small size of the lumbar pedicle.

Parallax and Distortion in Fluoroscopy Units.

Parallax is an imaging phenomenon where an object appears to be at different positions when viewed from different angles. Distortion can occur secondary to internal fluoroscopic, or external environmental, factors. Fluoroscopy is a vital tool to assist surgeons intraoperatively. However, parallax and distortion can lead to inaccuracy, potentially leading to incorrect surgical decisions. The purpose of this study was to investigate the prevalence of parallax/distortion in large fluoroscopy units at a level-1 trauma center. Two types of C-arm models were evaluated, including (1) round image intensifiers, and (2) flat plate detectors (FPD). A square plexiglass grid with embedded wire at ½-in intervals was created, with a round metal washer secured centrally. The grid was placed 16 in from the image intensifier. A metal ball bearing (BB) was secured to the center of the x-ray tube. Fluoroscopic images were obtained until the BB and washer were "center-center." A straight blade served as a fiducial marker to ensure there was no off-axis angulation. Standard anterior-posterior and lateral views were obtained. External factors were considered, tested, and limited. Images were printed and the patterns of parallax/distortion were identified. All 11/11 (100%) of fluoroscopy units had some degree of parallax and/or distortion. We noted 3 different patterns, including sigmoidal, converging, and diverging. The FPD units had less apparent distortion overall; however, two-thirds (66%) were off-axis in the x- and y-axes in relation to the fiducial marker. All fluoroscopy units had varying degrees and patterns of parallax/distortion. We noted less overall distortion in FPDs. However, some of these units may produce images that are off-axis. This research has important implications for improving the accuracy of intraoperative fluoroscopy. Musculoskeletal surgeons should understand the limitations of fluoroscopy and how to combat parallax distortion to improve surgical outcomes and reduce patient morbidity. Level V.

P604 Exploring the role of chest X-ray in latent tuberculosis screening in Inflammatory Bowel Disease

Abstract Background Patients being treated with biologics or JAK inhibitors have an increased reactivation risk of latent tuberculosis infection (LTBI), and this is associated with a more severe infective course. Current ECCO guidance recommends the screening for LTBI by a combination of patient clinical data and epidemiological factors, chest X-ray (CXR), and tuberculin skin test or interferon-gamma release assay (IGRA) prior to starting immunosuppressive treatment. The evidence supporting CXR is categorized at evidence level 5, and information on its use in screening for LTBI originates from two decades ago. Apart from radiation exposure, a single posterior-anterior view has limited diagnostic capabilities. This study aims to determine the relation between CXR findings and IGRA test results in patients undergoing LTBI screening before commencing immunosuppressive therapy for Inflammatory bowel disease (IBD) patients in a low-risk population. Methods This is a retrospective analysis whereby IBD patients (≥16 years) on biologics or JAK inhibitors were identified from our local database. The clinical data, epidemiological, CXR and IGRA result were then analysed from the electronic case records. The IGRA test used was the QuantiFERON-TB Gold. Results A total of 356 patients were included in the study, with 58.7% (n=209) being male. Among these patients, the majority had Crohn's disease (66.6%, n=236), 30.1% (n=109) had ulcerative colitis, and the remaining 2.8% were classified as having IBD-unclassified. Most patients (97.1%) had been exposed to anti-TNF alpha medications and 13.2% were exposed to multiple biologicals. The mean age of IBD diagnosis was 30.3 years (SD+/-15.7). None of the patients had any clinical suggestion nor any evidence for exposure to TB. None of the CXRs performed revealed any radiological signs of prior TB infection. 93.8% (n=334) of the IGRA results were negative and 4.2% (n=15) were categorized as indeterminate. Among those with indeterminate results, 66.7% (n=10) were undergoing corticosteroid treatment for active disease. The remaining 2.0% (n=7) had a positive IGRA test and were treated for LTBI.None of these patients had TB reactivation when then treated with biologicals. Conclusion This research highlights that performing routinely a CXR in individuals with a negative IGRA offers little to no benefit, and subjects patients to unnecessary radiation. It also demonstrates the importance of conducting the IGRA test early, before initiating any immunosuppressive treatment. Furthermore, in patients with a negative IGRA, if chest imaging is required for screening purposes, opting for an ultra-low dose CT might be more prudent than a CXR, as it visualises the lungs better and the radiation exposure is not substantially different.

Prediction of Pharyngeal 3D Volume Using 2D Lateral Area Measurements During Swallowing.

This study evaluated the validity of pharyngeal 2D area measurements acquired from the lateral view for predicting the actual 3D volume in healthy adults during swallowing. Seventy-five healthy adults (39 females, 36 males; mean age 51.3years) were examined using 320-row area detector computed tomography (320-ADCT). All participants swallowed a 10mL honey-thick barium bolus upon command while seated in a 45° semi-reclining position. Multi-planar reconstruction images and dynamic 3D-CT images were obtained using Aquilion ONE software. Pharyngeal 2D area and 3D volume measurements were taken before swallowing and at the frame depicting maximum pharyngeal constriction. Pharyngeal volume before swallowing (PVhold) was accurately predicted by 2D area (R2 = 0.816). Adding height and sex to the model increased R2 to 0.836. Regarding pharyngeal volume during maximum constriction (PVmax), 2D area also exhibited acceptable predictive power (R2 = 0.777). However, analysis of statistical residuals and outliers revealed a greater tendency for prediction errors when there is less complete constriction of the pharynx as well as asymmetry in bolus flow or movement. Findings highlight the importance of routinely incorporating anterior-posterior views during VFSS exams. Future work is needed to determine clinical utility of pharyngeal volume measurements derived from 320-ADCT.

단순 방사선 영상기반 바이오마커를 활용한 흉·요추의 추나의학적 변위 진단 방법

Objectives This study aimed to propose biomarkers for diagnosing Chuna manual therapy (CMT) based on X-ray images in the thoracic and lumbar spines.&#x0D; Methods Through a literature review and expert consensus process, diagnostic bio- markers for CMT were selected based on the listing system in thoracic and lumbar ra- diograph anterior-posterior (AP) and lateral views.&#x0D; Results 1. Diagnostic biomarkers were derived from four points on the outer contour of the vertebral body in the thoracic and lumbar spine radiograph lateral view, en- abling the diagnosis of flexion and extension malposition. 2. Additional diagnostic bi- omarkers were identified in the thoracic and lumbar radiographAP view, utilizing points on the outer contour of the vertebral body. These biomarkers facilitate the di- agnosis of lateral bending. Moreover, biomarkers derived from the innermost point of the pedicle contour allow for the diagnosis of rotation malposition. 3. Furthermore, through the biomarkers proposed in this study, all malpositions of the thoracolumbar spines and complex Type I and II malpositions can be diagnosed in CMT.&#x0D; Conclusions The biomarkers reported in this study consist of minimal points to de- termine the position of the vertebral body, providing the advantage of simplicity while minimizing potential errors during the CMT diagnostic process. Further clinical re- search and the development of related programs should be pursued to expand the evidence for CMT.

Diagnostic Accuracy of Lung Ultrasound in Diagnosis of Pneumonia in Children using Chest X-RAY as Gold Standard

Objective: To determine the diagnostic accuracy of lung ultrasound (LUS) in the diagnosis of pneumonia in children using chest x-ray as the gold standard. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Radiology, Combined Military Hospital, Sialkot Pakistan, from Feb to Aug 2021 Methodology: All patients underwent clinical examination, chest radiograph (anterior-posterior view), lung ultrasound and blood sample analysis in the first 24 hours after admission. A pre-specified hospital radiologist carried out a lung ultrasound. The examination was performed with the patient sitting upright or supine. The presence of pneumonia on x-ray and USG were recorded. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasound in the diagnosis of pneumonia by taking chest x-ray as the gold standard was calculated in all the study participants. Results: In this study, 262 patients with clinical features of pneumonia were enrolled. The mean age of the study participants was 3.27±2.344 years. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), accuracy and frequency of lung ultrasonography (US) vs chest radiography (CR) in diagnosing pneumonia was 95.28%, 87.5%, 99.59%, 36.84%, 95.04% and 96.95% respectively. Conclusion: Lung ultrasound emerged as a sensitive diagnostic tool to diagnose pneumonia in children. Sensitivity, specificity, positive predictive value, and negative predictive value all favoured the use of this modality to diagnose pneumonia in paediatric patients.

International Knee Documentation Committee Radiographic Knee Joint Grading More Reliable Than Kellgren-Lawrence Grading and Other Grading Systems

Kellgren-Lawrence grading appears to have become the de facto standard for reporting radiographic degeneration of knees, yet the much later–introduced and knee-specific International Knee Documentation Committee system has repeatedly been shown to have higher reliability. Although International Knee Documentation Committee radiographic grading does have limitations—especially in cases of severe gonarthrosis—it appears to be the most reliable current system suitable for the purposes of arthroscopic knee surgeons, and it was designed to encompass all 3 knee compartments. Posterior-anterior weight-bearing radiographs taken at approximately 45° of knee flexion have repeatedly been shown to be more sensitive for revealing tibiofemoral degeneration than standard anterior-posterior weight-bearing views at or near full extension.