Posteroanterior Chest Radiographs Research Articles

Forensic and clinical implications of scapula length: A radiological study in Delta State, Nigeria

Abstract Background: The morphometry of the scapula exhibits sexual dimorphism, which makes it crucial for sex determination in forensic contexts and guides orthopedic surgeons in the management of shoulder girdle fractures. Objective: This study aimed to establish population-specific discriminant formulas for sex determination using the scapula length from radiographs. Materials and Methods: This observational cross-sectional study retrospectively analyzed 200 postero-anterior chest radiographs (113 males and 87 females) from a referral hospital in Delta State, Nigeria. Inclusion criteria comprised fully ossified scapulae in patients aged 25–60 years. Scapula length was measured using digital calipers, and statistical analyses, including discriminant function analysis, were performed to create population-specific equations for sex prediction. Results: Males exhibited significantly longer scapulae than females. The right scapula length was longer and demonstrated higher overall accuracy (78.5%) in sex determination than the left scapula (75.0%). Combining right and left scapula lengths increased the accuracy to 83.0%. Conclusion: The study provides population-specific normative values for scapula length and highlights the sexual dimorphism of the scapula length. The length of the right scapula was more accurate in predicting sex (78.5%) and when combined with that of the left scapula, the accuracy increased (83.0%).

Hidden Behind Chronic Dyspeptic Symptoms: Post-traumatic Diaphragmatic Eventration

Abstract 
 Diaphragmatic eventration is commonly seen following high-energy traumas, particularly due to traffic accidents and falls from significant heights. This pathology has the potential to influence both the gastrointestinal and cardiorespiratory systems, presenting with a variety of symptoms. A 45-year-old male patient, with a history of trauma from falling off a tree, sought medical attention at our clinic with dyspeptic complaints and symptoms of shortness of breath. During the physical examination, diminished sounds were detected in the right lung field, along with epigastric tenderness. For diagnostic purposes, a posteroanterior chest radiograph (CXRs) and thoracic computed tomography (CT) scan were obtained. A subsequent bronchoscopy, performed with a pulmonology consultation, revealed decreased diaphragmatic movements. Taking into account the findings, a thoracic surgery treatment plan was devised for the patient. This case report underscores the significance of considering the seldom-encountered pathology of diaphragmatic eventration in patients presenting with dyspeptic and respiratory complaints. Keeping in mind that patients with such symptoms frequently turn to family physicians, it highlights the pivotal role of a multidisciplinary primary care approach in initiating the diagnostic trajectory.

Technical Quality and Diagnostic Impact of Chest X-rays in Tuberculosis Screening: Insights From a Saudi Teleradiology Cohort.

Objectives To assess the standard of chest X-ray techniques in tuberculosis (TB) screening within Saudi Arabian healthcare facilities and evaluate the impact of technical quality on radiological interpretation. Materials and methods Analysis of 250 posteroanterior chest radiographs sourced from a network of five clinics was conducted. These images were scrutinized for technical quality by a radiologist. Results Of the radiographs analyzed, 57% exhibited technical issues, with overexposure and clothing artifacts being the most commonly encountered. Notably, only 14% of these radiographs were deemed to have compromised diagnostic ability. Conclusion The presence of technical issues in most chest X-rays for TB screening highlights a significant area for improvement. However, the relatively low percentage of radiographs impacting diagnostic quality indicates that most issues do not critically hinder the radiologist's interpretative capability. This underscores the importance of balanced quality control measures in radiographic practices for effective TB detection in the region.

The Performance of a Deep Learning-Based Automatic Measurement Model for Measuring the Cardiothoracic Ratio on Chest Radiographs.

Prior studies on models based on deep learning (DL) and measuring the cardiothoracic ratio (CTR) on chest radiographs have lacked rigorous agreement analyses with radiologists or reader tests. We validated the performance of a commercially available DL-based CTR measurement model with various thoracic pathologies, and performed agreement analyses with thoracic radiologists and reader tests using a probabilistic-based reference. This study included 160 posteroanterior view chest radiographs (no lung or pleural abnormalities, pneumothorax, pleural effusion, consolidation, and n = 40 in each category) to externally test a DL-based CTR measurement model. To assess the agreement between the model and experts, intraclass or interclass correlation coefficients (ICCs) were compared between the model and two thoracic radiologists. In the reader tests with a probabilistic-based reference standard (Dawid-Skene consensus), we compared diagnostic measures-including sensitivity and negative predictive value (NPV)-for cardiomegaly between the model and five other radiologists using the non-inferiority test. For the 160 chest radiographs, the model measured a median CTR of 0.521 (interquartile range, 0.446-0.59) and a mean CTR of 0.522 ± 0.095. The ICC between the two thoracic radiologists and between the model and two thoracic radiologists was not significantly different (0.972 versus 0.959, p = 0.192), even across various pathologies (all p-values > 0.05). The model showed non-inferior diagnostic performance, including sensitivity (96.3% versus 97.8%) and NPV (95.6% versus 97.4%) (p < 0.001 in both), compared with the radiologists for all 160 chest radiographs. However, it showed inferior sensitivity in chest radiographs with consolidation (95.5% versus 99.9%; p = 0.082) and NPV in chest radiographs with pleural effusion (92.9% versus 94.6%; p = 0.079) and consolidation (94.1% versus 98.7%; p = 0.173). While the sensitivity and NPV of this model for diagnosing cardiomegaly in chest radiographs with consolidation or pleural effusion were not as high as those of the radiologists, it demonstrated good agreement with the thoracic radiologists in measuring the CTR across various pathologies.

Association of scoliosis with skeletal jaw asymmetry

ObjectiveThe objective of this study was to evaluate the relationship between scoliosis and skeletal jaw asymmetry. MethodsThe subjects were one hundred and thirty-eight (43 male, 95 female) patients with jaw deformity, who underwent surgical orthodontic treatment at Cyubu Rosai Hospital from April 2017 to March 2022, without congenital disease or scoliosis treatment history. Posteroanterior cephalograms and posteroanterior chest radiographs obtained before surgery were used to evaluate horizontal displacement of the jawbone, Cobb angle of scoliosis, respectively. Actual values of spines curved to the right and left of the body and of displacement of the mandible in these directions were both deemed positive and negative, respectively. Correlations between absolute values of spine and jaw displacement, namely values without regard to their direction, and correlations between actual values of spine and jaw displacement were analyzed using Spearman, non-parametric, and Pearson, parametric, tests respectively. ResultsTwenty-two patients (15.9 %) had Cobb angle > 10°. Although there was no significant correlation between Cobb angle and Me angle in the actual values (p = 0.606), there was a significant correlation in the absolute values (p = 0.023). ConclusionsThis study suggests a relationship between horizontal deviation of the mandible and scoliosis in patients with jaw deformity, albeit not necessarily in the same direction.

The Subgroup Imperative: Chest Radiograph Classifier Generalization Gaps in Patient, Setting, and Pathology Subgroups.

To externally test four chest radiograph classifiers on a large, diverse, real-world dataset with robust subgroup analysis. In this retrospective study, adult posteroanterior chest radiographs (January 2016-December 2020) and associated radiology reports from Trillium Health Partners in Ontario, Canada, were extracted and de-identified. An open-source natural language processing tool was locally validated and used to generate ground truth labels for the 197 540-image dataset based on the associated radiology report. Four classifiers generated predictions on each chest radiograph. Performance was evaluated using accuracy, positive predictive value, negative predictive value, sensitivity, specificity, F1 score, and Matthews correlation coefficient for the overall dataset and for patient, setting, and pathology subgroups. Classifiers demonstrated 68%-77% accuracy, 64%-75% sensitivity, and 82%-94% specificity on the external testing dataset. Algorithms showed decreased sensitivity for solitary findings (43%-65%), patients younger than 40 years (27%-39%), and patients in the emergency department (38%-60%) and decreased specificity on normal chest radiographs with support devices (59%-85%). Differences in sex and ancestry represented movements along an algorithm's receiver operating characteristic curve. Performance of deep learning chest radiograph classifiers was subject to patient, setting, and pathology factors, demonstrating that subgroup analysis is necessary to inform implementation and monitor ongoing performance to ensure optimal quality, safety, and equity.Keywords: Conventional Radiography, Thorax, Ethics, Supervised Learning, Convolutional Neural Network (CNN), Machine Learning Algorithms Supplemental material is available for this article. © RSNA, 2023See also the commentary by Huisman and Hannink in this issue.

Tuberculosis contact-tracing results in childhood: a retrospective study in a tertiary-care children’s hospital in Turkey

ABSTRACT Background Smear-positive adults with tuberculosis are the main source of childhood tuberculosis. The evaluation of children exposed to tuberculosis and determination of the disease stages are the cornerstones of managing childhood tuberculosis. Aim To determine the frequency of tuberculous contact, latent tuberculosis infection and tuberculosis disease in children who were in contact with smear-positive adults. Methods This is a single-centre, retrospective study. The medical records of children exposed to tuberculosis (<18 years old) between 2014 and 2018 were investigated. After diagnosing the index cases, the children were referred to the hospital. To identify the children in contact with adults with tuberculosis, a careful medical history, demographic features and physical examination, tuberculin skin test, postero-anterior and lateral chest radiographs, and, if necessary, chest computed tomography and microbiological tests were undertaken. The children’s final diagnosis, treatment regimens and follow-up were documented. The sensitivity, specificity and positive and negative predictive values, tuberculin skin test and chest radiograph imaging were assessed and compared with computed tomography results. Results A total of 150 paediatric patients were exposed to 88 index cases. These were fathers in 29.3% of cases and mothers in 10% of cases. Of the children, 131 (87.3%) were asymptomatic, and physical examination was normal in all children, apart from one who had respiratory symptoms. The tuberculin skin test results were positive in 60 (43%) patients and chest radiograph was abnormal in 100 (66%) children. Findings were consistent with tuberculosis in 34 (40%) of the 84 patients who underwent computed tomography. Fifty (38.5%) of the remaining children were defined as having been in contact with a case of tuberculosis, 41 (31.5%) had latent tuberculous infection and 39 (30%) had tuberculosis disease. Conclusion Pulmonary tuberculosis is asymptomatic in most children but with meticulous use of computed tomography it can be detected in asymptomatic children who have had close contact with tuberculosis. Abbreviation: AFB: acid-fast bacilli; AUC: area under the curve; BCG: bacillus Calmette-Guérin; CI: confidence interval; CT: computed tomography; CXR: chest radiograph; HIV: human immunodeficiency virus; ICD-10: International Classification of Diseases 10; LTBI: latent tuberculosis infection; MDR-TB: multi-drug-resistant tuberculosis; NPV: negative predictive value; PCR: polymerase chain reaction; PPV: positive predictive value; ROC: receiver operating characteristics; SD: standard deviation; TB: tuberculosis; TST: tuberculin skin test; XDR-TB: extensively drug-resistant tuberculosis.

Factors predict the adequacy of cervical mediastinoscopy in nonsmall cell lung carcinoma lymph node staging and comparison computed tomography and integrated positron emission tomography

Background Standard cervical mediastinoscopy (SCM) has traditionally been considered the reference standard for grading mediastinal involvement in lung cancer. The objective of this research is to evaluate the impact of surgeon experience and patient-related restrictions on the adequacy of mediastinal lymph node (LN) sampling. Additionally, we aim to assess the effectiveness of PET/computed tomography (CT) in comparison to ECM (extended cervical mediastinoscopy), particularly in identifying metastases in the aortopulmonary window (APW) LN. Methods This prospective cohort study involved sixty individuals diagnosed with nonsmall cell lung cancer (NSCLC). The participants underwent fine needle transthoracic aspiration biopsy or bronchoscopy and subsequently had ECM performed. All participants underwent various diagnostic procedures, including thoracic CT, posteroanterior chest radiograph, pulmonary function tests, PET/CT, electrocardiography, cranial magnetic resonance imaging, and laboratory investigations. Results In terms of our outcomes, we evaluated the specificity, positive predictive value (PPV), sensitivity, negative predictive value (NPV), and accuracy of ECM. The results for ECM were as follows specificity of 100.0%, PPV of 100.0%, sensitivity of 78.3%, NPV of 88.1%, and accuracy of 91.7%. For PET/CT, the results were: a specificity of 90.5%, PPV of 75.0%, sensitivity of 57.1%, NPV of 80.9%, and accuracy of 78.3%. Conclusion The ECM procedure is highly beneficial in identifying APW LN metastasis in individuals diagnosed with nonsmall cell lung cancer. It exhibits a favorable NPV and efficiency. Moreover, it can be easily performed by a team with the necessary experience.

The Prevalence of Scoliosis among Adolescent Chest Radiographs Obtained at Tikur Anbessa Specialized Hospital in 2019.

Scoliosis is an abnormal side-to-side spinal curve of greater than or equal to 100 Cobb angle. It is the most common spinal deformity in children and adolescents. Epidemiological evidence about scoliosis is scarce in Africa, including Ethiopia. This study was aimed at determining the prevalence of scoliosis among adolescents and analysing its association with age and sex using plain chest radiographs obtained for non-spinal reasons in Tikur Anbessa Specialized Hospital. All non-tilted, non-rotated, and non-poorly penetrated digital plain chest radiographs of adolescents aged 10 to 19 years obtained at Tikur Anbessa Specialized Hospital between January 1 and December 31, 2019, were measured for the coronal Cobb angle. The data were cleaned, coded, and entered into SPSS version 26 for analysis. Chi-square, and linear regression, and logistic regression analyses were also carried out to evaluate the effect of sex and age on scoliosis. The Cobb angles of 1,369 posteroanterior chest radiographs of adolescents were measured. Thirty (2.2%, 95% CI: 1.4%, 3.0%) of these were found to have scoliosis. The mean coronal Cobb angle was 2.270±6.320. There was no statistically significant difference between the prevalence of scoliosis in boys (2.21%) and girls (2.17%) (X2=0.003, P=0.954). Likewise, age did not show any statistically significant difference in the prevalence of scoliosis (X2=2.655, P=0.265). This study revealed that incidental finding of adolescent scoliosis in plain chest radiographs is common. Further study using whole spine radiography should be carried out to determine the true general population prevalence of scoliosis in Ethiopia.

Assessment of the Cardiothoracic Ratio and Its Association with Gender and Age: A Nigerian Study

Cardiothoracic ratio (CTR) evaluation is a useful screening method used to detect cardiomegaly. It varies in different populations due to genetic, geographical and environmental factors that influence body morphology. This study aimed at assessing the CTR and determining its association with gender and age among adult Nigerians. This retrospective cross-sectional study was conducted in the Radiology Department of a Teaching Hospital in Delta State after obtaining ethical clearance. Postero-anterior chest radiographs of 200 adults (108 males and 92 females) were used to measure the transverse cardiac diameter (TCD) and transverse thoracic diameter (TTD) in centimeters (cm). These were used to compute the CTR (TCD/TTD*100). Statistical Package for Social Sciences version 22.0 was used to analyze the data. Independent t-test and analysis of variance (ANOVA) were used to determine the differences in the measurements with regards to gender and age-groups respectively. The correlation that exists between the variables and their association with age were assessed using Pearson’s correlation. P value was set at &lt; 0.05. The TTD and TCD were significantly larger in males than in females (p=0.001 each) while the CTR was significantly larger in females than in males (p=0.016). The TTD and CTR showed significant differences in the various age groups (p=0.002, 0.031) (p=0.195). The two diameters showed a significant positive correlation with age (0&lt;r&lt;0.5). The study provides the normal mean CTR values for the studied population based on age and gender which will help clinicians in the screening for heart conditions. This will enhance early diagnosis and intervention. Keywords: cardiomegaly, thoracic diameter, cardiac diameter, chest radiographs, diagnosis, cardiothoracic ratio

Clinical profile, surgical management and outcome of bronchial carcinoids - a single centre experience

Background and objectives: Bronchial carcinoid tumors are neuroendocrine neoplasms that range from low-grade typical carcinoids to more aggressive atypical carcinoids and, therefore demonstrate a wide spectrum of clinical behaviors, histologic features and outcome. The aim of the present study was to investigate the clinical profile, surgical management and outcome of bronchial carcinoids at a single centre over two years period. Materials and methods: Patients with a final histologic diagnosis of bronchial carcinoid tumor were included in the study. Evaluation comprised of clinical history and physical examination, postero-anterior and lateral chest radiographs, and computed tomographic (CT) scans of the chest and upper abdomen (including liver and adrenal glands). Performance status was assessed by the Karnofsky scale. Pulmonary function tests were performed routinely. Results: A total of 18 patients were included in the study. Out of 18 cases, 10 (55.6%) were female and 8 (44.4%) were males. Sixteen (88.9%) patients had typical carcinoid tumor and 2 (11.1%) had atypical carcinoid tumor. The tumor was located in the right lung in 11 (61.1%) and in the left lung in 7 patients (38.9%). Surgeries included 15 standard lobectomies and 3 bronchial sleeve resection. At one month post surgery, there was 13-22% increase in post operative FEV1 in patients who underwent bronchial sleeve resection while in patients who underwent lobectomy, the post operative FEV1 was 84% of pre-operative FEV1. Post surgery, all patients were in group A as per Karnofsky performance status. Conclusion: Standard care of bronchial carcinoid tumors is surgical resection, and the surgical approach should depend on tumor’s size, location and histology. IMC J Med Sci. 2023; 17(2):003. DOI: https://doi.org/10.55010/imcjms.17.013 *Correspondence: Farooq Ahmad Ganie, Department of Cardiovascular and Thoracic Surgery, SKIMS, Soura, Srinagar, Kashmir, India. Email: farooq.ganie@ymail.com

A survey investigating postero-anterior chest X-ray clinical technique amongst radiographers and assistant practitioners in the UK: An extended pilot study

IntroductionWhilst many technical factors for the postero-anterior (PA) chest projection are well-researched and standardised, anecdotal evidence suggests a discrepancy regarding positioning of the X-ray tube; some radiographers using a horizontal tube, and others apply an angle. Currently there is a lack of published evidence supporting the benefits of either technique. MethodsFollowing University ethical approval, an invitation e-mail containing a link to a short questionnaire and participant information sheet was sent to radiographers and assistant practitioners in Liverpool and the surrounding areas, via professional networks/research team contacts. Questions related to length of experience, highest qualification and reasoned choice of horizontal versus angled tube preference in Computed Radiography (CR) and Digital Radiography (DR) rooms. The survey was open for nine weeks, with reminders at five and eight weeks. ResultsThere were 63 respondents. Both techniques were commonplace, with a non-statistically significant preference (p = 0.439) for a horizontal tube in both DR rooms (59%, n = 37) and CR rooms (52%, n = 30). Angled technique was employed by 41% (n = 26) of participants in DR rooms and 48% (n = 28) in CR rooms. Many participants indicated ‘taught’, or ‘protocol’, influenced their approach (46% [n = 29] in DR, 38% [n = 22] in CR). 35% (n = 10) of participants using caudal angulation, identified dose optimisation as the rationale in both CR and DR rooms. Most specifically noted reduced dose to the thyroid (69% [n = 11] in CR, 73% [n = 11] in DR). ConclusionsThere is evidence of variation in practice regarding horizontal versus an angled X-ray tube but no consistent rationale for either choice. Implications for practiceThere is a need to standardise tube positioning in PA chest radiography in line with future empirical research into the dose-optimisation implications of tube angulation.

Autonomous Chest Radiograph Reporting Using AI: Estimation of Clinical Impact.

Background Automated interpretation of normal chest radiographs could alleviate the workload of radiologists. However, the performance of such an artificial intelligence (AI) tool compared with clinical radiology reports has not been established. Purpose To perform an external evaluation of a commercially available AI tool for (a) the number of chest radiographs autonomously reported, (b) the sensitivity for AI detection of abnormal chest radiographs, and (c) the performance of AI compared with that of the clinical radiology reports. Materials and Methods In this retrospective study, consecutive posteroanterior chest radiographs from adult patients in four hospitals in the capital region of Denmark were obtained in January 2020, including images from emergency department patients, in-hospital patients, and outpatients. Three thoracic radiologists labeled chest radiographs in a reference standard based on chest radiograph findings into the following categories: critical, other remarkable, unremarkable, or normal (no abnormalities). AI classified chest radiographs as high confidence normal (normal) or not high confidence normal (abnormal). Results A total of 1529 patients were included for analysis (median age, 69 years [IQR, 55-69 years]; 776 women), with 1100 (72%) classified by the reference standard as having abnormal radiographs, 617 (40%) as having critical abnormal radiographs, and 429 (28%) as having normal radiographs. For comparison, clinical radiology reports were classified based on the text and insufficient reports excluded (n = 22). The sensitivity of AI was 99.1% (95% CI: 98.3, 99.6; 1090 of 1100 patients) for abnormal radiographs and 99.8% (95% CI: 99.1, 99.9; 616 of 617 patients) for critical radiographs. Corresponding sensitivities for radiologist reports were 72.3% (95% CI: 69.5, 74.9; 779 of 1078 patients) and 93.5% (95% CI: 91.2, 95.3; 558 of 597 patients), respectively. Specificity of AI, and hence the potential autonomous reporting rate, was 28.0% of all normal posteroanterior chest radiographs (95% CI: 23.8, 32.5; 120 of 429 patients), or 7.8% (120 of 1529 patients) of all posteroanterior chest radiographs. Conclusion Of all normal posteroanterior chest radiographs, 28% were autonomously reported by AI with a sensitivity for any abnormalities higher than 99%. This corresponded to 7.8% of the entire posteroanterior chest radiograph production. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Park in this issue.

COMPARISON AND CORRELATION OF CARDIOTHORACIC RATIO ON CHEST RADIOGRAPH AND COMPUTED TOMOGRAPHY

Chest radiograph is an easily available non invasive tool in evaluation of health. The cardiothoracic ratio (CTR) is commonly used as an indicator of cardiomegaly in clinical radiology. It can promptly diagnose congestive cardiomegaly apart from other lung and pleural pathologies and also depicts repsonse to treatment given, like diuretics in heart failure. Although there are better modalities available like echocardiography, computed tomography and magentic resonance imaging, chest radiography and cardiothoracic ratio are still being used by clinicians, especially in emergency department, intensive care unit and for frequent follow ups . CTR is calculated by dividing the cardiac diameter (CD) by the thoracic diameter (TD) as measured on posteroanterior chest radiography (chest PA). CTR of &gt;0.5 is abnormal on an inspiratory breath-hold chest radiograph. The purpose of this study was to compare the statistical correlation of CTR between chest radiograph with CT and to present real Heart Size (HS), Thoracic Size (TS), and Cardiothoracic Ratio (CTR) on chest PA and chest AP in the DR system and in computed tomography (CT). The conclusion of the study is that the measurement of CTR from radiograph &amp; computed tomography (CT) from both axial &amp; coronal reformations were concordant with another

Diagnosis, treatment, and potential causative mutations of cryptogenic plastic bronchitis.

Diagnosis, treatment, and potential causative mutations of cryptogenic plastic bronchitis.

The study of bone mass measurement by clavicle radiogrammetry in a comparison to the dual energy x-ray absorptiometry examination

Background: Clavicle radiogrammetry test related to chest radiography has been found to be useful in evaluation of osteoporosis. The diagnosis of osteoporosis was based on the measurement of bone mineral density (BMD) with dual energy x-ray absorptiometry. Objectives: The aim of this study was to evaluate bone mass measurement using clavicle radiograms to differentiate the goal standards related to the dual energy x-ray absorptiometry methods. Materials and methods: The population sample consisted of a 100 healthy Thai adult volunteers, (50 women, 50 men) aged from 24 to 76 years. The study subjects were divided as normal bone mass group, T-score ≥ -1.0 and the low bone mass group, T-score ≤ -1.0. Subsequently, posteroanterior (PA) chest radiographs were taken. Measurements of the clavicle radiograms were evaluated, and the images at the midshaft of both clavicles were calculated. An independent t-test was used to examine the differences between the normal and the low bone mass of each gender and two separate BMD sites. The confidence interval was 95% at level of significance 0.05. Pearson’s correlation was used to measure the strength and direction of linear relationship between the bone mass measurement using the dual energy x-ray absorptiometry (DEXA) test and clavicle radiogrammetry test. Results: The results showed 18 women and 28 men maintained a normal BMD, while 32 women and 22 men had low bone mass density. The average clavicle thickness measurements of the normal bone mass of the women group were lower than the normal bone mass measurements of men. Conversely, the low bone groups of women measurements were higher than low bone mass in the men’s group. A greater diminishing of cortical thickness of clavicle was found in the low bone mass than normal group for both genders. The average cortical thickness of clavicle in the low bone mass of women decreased by 17.8% (5.31 mm/6.46 mm) compared to normal women, while in men, which were fewer, 16.13% (7.07 mm/8.43 mm) between groups, respectively. The average measurements of the clavicle periosteal width and combined cortical thickness of clavicle showed a positive correlation with BMD, whereas, the clavicle endosteal width showed a negative correlation with BMD. Conclusion: Using the radiogrammetric method to measure the clavicle cortex thickness on the chest x-ray images showed a gradual thinning of the cortex with aging. By comparison, the measurements of clavicle cortex thickness showed a moderate relationship with BMD performed by DEXA in the assessment of osteoporosis.

Biometric Data of Adults’ Aortic Knob Diameter in Posteroanterior Chest Radiograph, Correlation to Age and Normative Heart Diameter: A Cross-Sectional Study

Background: The aortic knob (AK) is an essential feature on a chest x-ray. It could be the first sign of a cardiovascular problem if there is any deformation or enlargement of the knob. This study aimed to measure the normal AK diameter (AKD) on a posteroanterior chest radiograph in healthy adult Sudanese. Methods and Results: The study was conducted in the Department of Radiology and Imaging in Ribat Hospital (Sudan) between Jun 2019 and Jan 2020. A total of 113 participants of both sexes (45.1% males and 54.9% females) with a normal chest x-ray and no history of diabetes, blood hypertension, cardiovascular disease, or skeletal abnormality were selected. Participants' age fluctuated from 18 to 75 years. The measurements (AK, heart diameter [HD], cardiothoracic ratio [CTR]) were carried out with the measuring tools available on the software of the computed radiography system. The mean AKD was 2.8±0.8 cm (2.94±0.8 cm in males and 2.51±0.77 cm in females, P=0.005)). The mean HD was 9.22±2.8 cm (9.8±3.3 cm in males and 8.7±0.2.1 cm in females, P=0.005). The mean CTR was estimated as 46.6±7.7% with a significant difference between males and females and significantly correlated with HD and BMI (P&lt;0.05). The AKD increased by 0.019 cm with an increase of one year of age (AKD = 0.0199(age)+1.9469), and there was a strong positive correlation between age and AKD (P&lt;0.001). Conclusion: The study found a significant positive correlation between age and AKD. Increased heart sizes increase AKD. The AKD value is greater in males than in females.

EFFECT OF PELVIC LEAD SHIELD ON ORGAN DOSES IN POSTERO-ANTERIOR CHEST RADIOGRAPHY.

Lead shields are commonly used in X-ray imaging to protect radiosensitive organs and to minimise patient's radiation dose. However, they might also complicate or interfere with the examination, and even decrease the diagnostic value if they are positioned incorrectly. In this study, the radiation dose effect of waist half-apron lead shield was examined via Monte Carlo simulations of postero-anterior (PA) chest radiography examinations using a female anthropomorphic phantom. Relevant organs for dose determination were lungs, breasts, liver, kidneys and uterus. The organ dose reductions varied depending on shield position and organ but were negligible for properly positioned shields. The shield that had the largest effective dose reduction (9%) was partly positioned inside the field of view, which should not be done in practice. Dose reduction was practically 0% for properly positioned shields. Therefore, the use of lead shield in the pelvic region during chest PA examinations should be discontinued.

Patient's posteroanterior chest radiographs are routinely displayed at different sizes on PACS: Cause and prevalence

ObjectiveSequential posteroanterior chest radiographs (CXRs) on any one patient are commonly displayed at different sizes on PACS monitors. The purpose of this study was to determine the cause of these differences, the percentage of radiographs affected, the relative change in magnification seen and if radiologists were aware of this display difference. MethodsDifferences in routine radiographer collimation pre-acquisition and image cropping (shuttering) post acquisition were noted. From three different hospitals, 300 posteroanterior (PA) erect CXRs with prior comparative studies were viewed side-by-side on a standard landscape display monitor. Variation in display size was calculated using the number of detector elements in the autofitted axis of the radiograph, when compared with the prior study. Correlation between patient gender and extent of magnification between images was recorded. Following this, a national survey was circulated to see if radiologists were aware of this phenomenon. ResultsLarge variations in display size were noted. The mean extent of magnification between sequential PA chest radiographs was ±6.8% (range 0–21.6%). 98% of CXRs had some degree of variability in display size. There was no significant difference in the extent of variation in magnification based on age or gender. 86% of the radiologists who responded to the survey (n = 132) were unaware of any display size variability. ConclusionSequential DR acquired chest radiographs are routinely displayed with varying degrees of magnification on PACS monitors due to differences in radiographer practice and auto-fit display settings. Most radiologists surveyed were unaware of these differences and their causation.

Effects of delayed breast reconstruction on the thoracolumbar vertebrae in patients undergoing unilateral mastectomy: A retrospective cohort study

Post-mastectomy changes vertebral column alignment. There is limited data assessing spine curvature after breast reconstruction. In this study, the effects of delayed breast reconstruction on the Cobb angle and quality of life indicator (Oswestry disability index [ODI]) were evaluated in patients undergoing unilateral mastectomy. This study was performed as a retrospective review of 40 patients who had delayed reconstruction for breast cancer at a single center between 2015 and 2018. Patients completed a standardized questionnaire, the ODI, at the beginning and 12 months after the operation. The Cobb angles of the vertebral columns and spinal curve directions were determined using posteroanterior chest radiographs obtained pre- and postoperatively. Mean age and body mass index (BMI) were 49.9±9 years and 30.1kg/m2, respectively. The Cobb angles were found to differ before and after the reconstruction; the difference was statistically significant, and the average change in Cobb angle was 4.3° (p=0.03). The Cobb angles were also found to be significantly different between patients with implants and those who underwent autologous tissue reconstruction (p=0.026). Although delayed reconstruction performed with autologous tissue or implant improves post-mastectomy scoliosis, autologous tissue reconstruction yields better outcomes. The mean preoperative ODI score was 21.6%, and 8.8% patients presented no back pain. The mean score was 3.2% at 12 months postoperation. These results are statistically significant (p<0.001). Breast reconstruction positively affects vertebral alignment and leads to better posture, physical function and decreased back pain in breast cancer survivors, significantly improving their quality of life.