Radiographic Modalities Research Articles

Evaluation of the Role of Cone-Beam Computed Tomography as an Adjunctive Radiographic Modality to Enhance the Surgical Outcomes in Obstructive Sleep Apnoea Patients

Purpose: To evaluate the integration of Cone-beam Computed Tomography (CBCT) as an auxiliary radiographic modality for airway assessment to pinpoint blockage locations and improve Obstructive Sleep Apnea (OSA) surgical results. Material and methods: Thirty-eight OSA patients were selected from the ENT outpatient clinic, Faculty of Medicine, Mansoura University, and divided into two equal groups. After performing polysomnography and recording the Apnea Hypoapnea Index (AHI), Drug-Induced Sleep Endoscopy (DISE) was carried out for both groups. CBCT imaging was performed for group (1) patients only. Afterward, the otolaryngologist selected the suitable surgical procedure for all patients. Post-surgical results were assessed six months after surgery. Another polysomnography was used to compare the postoperative AHI value to the preoperative value. At least a 50% reduction in the postoperative value was considered a conventional surgical success. Results: A significant difference in AHI values before and after the operation between both groups was shown. Group (1) reduced by 55.7% more than group (2), which reduced by 30.7%. There was no statistically significant difference between the success rates of the two groups. Conclusion: CBCT quantifies airway obstruction preoperatively, serving DISE, and thus improving OSA surgical success. Better collapse extent assessment using CBCT improves results and prospects. Future studies should explore specialists' CBCT use with larger sample sizes and a wider spectrum of OSA patients with different AHI levels.

Enhancing Diagnostic Accuracy: A Hybrid Approach to Mitigate Speckle and Rician Noise in Medical Images

This research explores the detrimental effects of Rician and speckle noise in medical imaging, particularly within MRI and radiographic modalities. Such noise can significantly obscure critical details, potentially leading to misdiagnoses and inaccurate measurements. Rician noise candidly dangles on the signal strength. Removing this noise affects the origial information in image that makes this noise removal perplexing. On other hand speckle noise is visualised like granular clog in ultrasound imageries. It creates ambiguous details and edges in the images. To address this challenge, the study introduces a novel hybrid method implemented in Java. The method employs a frequency-based decomposition approach for speckle noise and separates images into magnitude and phase components for Rician noise. This allows for targeted filtering, utilizing customized versions of median and Gaussian filters, to effectively remove noise while preserving crucial image features. The proposed method was rigorously assessed using 200 contaminated brain and lung MRIs and radiographs, demonstrating superior performance compared to traditional filters based on crucial system of measurement like Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index (SSIM), and Mean Squared Error (MSE). This research presents a promising solution for enhancing the quality and reliability of medical images, potentially leading to improved diagnostic accuracy and patient outcomes.

Dynamic chest radiographic evaluation of the effects of tiotropium/olodaterol combination therapy in chronic obstructive pulmonary disease: the EMBODY study protocol for an open-label, prospective, single-centre, non-controlled, comparative study

IntroductionTo date, there is limited evidence on the effects of bronchodilators on respiratory dynamics in chronic obstructive pulmonary disease (COPD). Dynamic chest radiography (DCR) is a novel radiographic modality that...

Patellofemoral instability in children and adolescents

Patellofemoral instability is acommon and clinically relevant disorder of multifactorial causes. Several concomitant problems such as genua valga, hyperlaxity, injuries or sports-related overuse may contribute to the development of instability and recurrent patellar dislocations. Athorough diagnosis is of paramount importance to delineate every contributing factor. This includes radiographic modalities and advanced imaging such as magnetic resonance imaging or torsional analyses. The authors recommend non-operative management (including physiotherapy, gait and proprioceptive training, orthoses) and, whenever non-operative measures fail, surgical patellar stabilization using, e.g. MPFL reconstruction.

Radiographic assessment of the peri-implant site.

While peri-implant mucositis relies solely on clinical parameters, radiological assessment becomes indispensable for diagnosing peri-implantitis. Intraoral radiography, with its simplicity of application, low radiation exposure, and adequate representation of peri-implant structures, stands out as the standard of care for both immediate and follow-up assessments. Standardization by custom-made radiologic splints allows for excellent comparability with previous images and allows for the determination of even small changes in contour and density of the peri-implant bone. Furthermore, other radiographic modalities like panoramic radiography and cone beam computed tomography (CBCT) may provide useful features for specific patients and clinical cases while also showing innate limitations. Beyond the assessment of the marginal peri-implant bone level as the crucial parameter of clinical relevance, radiologic assessment may reveal various other findings related to the prosthetic restoration itself, the precision of its fit to the implant, and the peri-implant soft and hard tissues. Since such findings can be crucial for the assessment of peri-implant health and the implants' prognosis, a systematic diagnostic evaluation pathway for a thorough assessment is recommended to extract all relevant information from radiologic imaging. This article also provides an overview of the clinical and chronological indications for different imaging modalities in peri-implant issues.

Trauma of the midface : Symptoms, diagnostics and treatment

Midface fractures present aclinical challenge in otorhinolaryngology due to their often complex injury pattern and nonspecific symptoms. Precise diagnostics, including differentiated imaging procedures, are required. Interdisciplinary consultation between otorhinolaryngology, maxillofacial surgery, neurosurgery, and ophthalmology is often necessary. When selecting radiographic modalities, radiation hygiene should be taken into account. Sonography provides aradiation-free imaging alternative for fractures of the nasal framework and anterior wall of the frontal sinus. The goal of treatment is to achieve stable and symmetrical reconstruction. Depending on the injury pattern, different osteosynthesis materials, individual access routes, and various surgical procedures can be used. In clinical practice, the management of midface fractures requires amultidisciplinary, flexible, and pragmatic approach based on the fracture pattern and clinical experience.

Software-supported periodontal diagnostics with 3D CBCT compared with conventional 2D panoramic imaging and clinical diagnostics: a prospective study.

The objective of the present study was the software-supported evaluation of the measurement accuracy between CBCT and panoramic radiographs in the assessment of the periodontal bone level in patients with periodontitis, and the comparison of this with clinical periodontal parameters. Twenty patients with severe periodontitis (stage III to IV) were evaluated clinically and radiographically (panoramic radiographs and CBCT). Diagnostic interpretation comprised three blinded investigators with different levels of experience. Specific software-basing measurement procedure evaluated radiologic distances for the mesial, central, and distal bone levels on the oral and vestibular sides of the teeth investigated and furcation upper and lower boundary. Jaw localization, anatomical region of interest, the number of roots, and the experience of the observers were evaluated. All measurements were carried out twice by the same observers within a 6-week interval. Slightly higher measurement deviations (SD) in the range of 0.47 (0.40) mm were found for CBCT evaluation compared with panoramic imaging. Pearson correlation analysis showed statistically strong positive correlation for the mesial and distal aspects, and moderate positive correlation was found for the investigated furcations between both radiographic modalities. Compared with the clinical reference, the mean total error of measurement (SD) was larger for panoramic imaging (0.66 [0.48] mm) than for CBCT (0.27 [0.08] mm) for all three observers. Software-supported CBCT analysis delivers better diagnostic information about the bony periodontal conditions of the patient compared with 2D radiographs. However, it remains unclear if this additional information leads to better periodontal outcomes.

Impact of Education and Experience on Radiographers' Ability to Diagnose Acute Appendicitis: A Survey in Private Malaysian Hospitals.

Acute appendicitis is a global surgical emergency. Radiographic modalities usually identify acute appendicitis, although radiographers' competence is questionable. This study examines how clinical radiographers' education and experience affect their ability to identify acute appendicitis using computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography (USG) characteristics. The study also aimed to determine which variable strongly influences their knowledge level. The study surveyed radiographers with a four-part self-administered questionnaire containing demographic information and eight knowledge-based questions about the appearance of acute appendicitis in MRI, CT and USG, separately. Before distribution, the questionnaire was validated and checked the reliability. Clinical radiographers' knowledge about using MRI to diagnose acute appendicitis was strongly affected by education and experience (η2 = 0.13 and 0.14; P < 0.05), with bachelor's degree holders scoring higher regardless of experience. Radiographers with more than 5 years of experience knew more about CT and USG features to identify acute appendicitis (η2 = 0.40 and 0.27; P < 0.05). Radiographers with a bachelor's degree and greater experience had higher overall knowledge of MRI, CT and USG to diagnose acute appendicitis (η2 = 0.51 and 0.11; P < 0.05). With adjusted R2 = 54% (F [2, 44] = 27.94; P < 0.001), education and experience highly predicted the overall knowledge level. The study found gaps in radiographers' knowledge of the radiographic appearance of acute appendicitis. Clinical radiographers' education level and years of experience substantially affect their knowledge level. In addition, experience is a good predictor than education level for overall knowledge level. Therefore, the study emphasises the importance of continuing education and training for radiographers to diagnose acute appendicitis quickly and accurately.

Determination of the position of impacted maxillary canine – A panoramic radiographic study

Maxillary canines are one of the most common impacted teeth. The objective in localization of an impacted canine is to be able to decide such a radiographic technique which has minimal radiation dose, cost and minimum superimpositions. Panoramic radiograph, being a screening radiograph, can satisfy the above needs. Taking this into consideration, the present study was done to evaluate the reliability of panoramic radiograph in localization of impacted permanent maxillary canines, when compared to cone-beam computed tomography.OPG and CBCT images of 100 maxillary impacted canines were included in the study irrespective of site. Each OPG was evaluated for vertical angulation and the data obtained was tabulated and subjected to statistical analysis.In the present study, the female to male ratio was 2.57:1, with a slightly higher prevalence of impacted maxillary canines on left side. The results of the present study show a 100% concordance between OPG and CBCT for palatal and buccal impactions, and 91% for mid-alveolus impactions.Based on the results of the present study, it may be concluded that panoramic radiographs are useful for predicting the location of impacted maxillary canines against the confirmatory radiographic modality like CBCT.

Enhancing Diagnostic Accuracy: A Hybrid Approach to Mitigate Speckle and Rician Noise in Medical Images

This research explores the detrimental effects of Rician and speckle noise in medical imaging, particularly within MRI and radiographic modalities. Such noise can significantly obscure critical details, potentially leading to misdiagnoses and inaccurate measurements. Rician noise candidly dangles on the signal strength. Removing this noise affects the origial information in image that makes this noise removal perplexing. On other hand speckle noise is visualised like granular clog in ultrasound imageries. It creates ambiguous details and edges in the images. To address this challenge, the study introduces a novel hybrid method implemented in Java. The method employs a frequency-based decomposition approach for speckle noise and separates images into magnitude and phase components for Rician noise. This allows for targeted filtering, utilizing customized versions of median and Gaussian filters, to effectively remove noise while preserving crucial image features. The proposed method was rigorously assessed using 200 contaminated brain and lung MRIs and radiographs, demonstrating superior performance compared to traditional filters based on crucial system of measurement like Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index (SSIM), and Mean Squared Error (MSE). This research presents a promising solution for enhancing the quality and reliability of medical images, potentially leading to improved diagnostic accuracy and patient outcomes.

Dental Attrition and its Association With the Signs and Symptoms of TMJ Dysfunction and Radiographic Condylar Changes – An Observational Study

ABSTRACT To determine the level of dental attrition and its relation to signs of TMJ dysfunction adding to condylar alterations analyzed by conventional TMJ Tomography and to propose the correlation between dental attrition and signs of TMJ dysfunction and condylar changes. Patients for the study were selected from the regular outpatient Department of Oral Medicine, Diagnosis and Radiology, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, with performed criteria. The radiographic examination of TMJ is performed by the PLANMECA OPG machine using the tomographic program. Statistical analysis was performed using a Chi-square test to determine the relation between attrition and temporomandidular disorders [TMD] signs and symptoms. The study group comprises 60 subjects who are having dental attrition, and they are divided into three groups according to their age: Group I, 20-40 age; Group II, 41-60 age; Group III, more than 60 age 80% of the samples had one or more tooth with significant attrition with grades of two or more on a 0-4 scale The prevalence of changes in condylar morphology was more in individuals above 40 yrs (33.33%) as compared to those below the age of 40 with a total prevalence of 41.67%. The most common symptom reported is tooth sensitivity, joint sounds, and muscle tenderness. The last reported are scalloped tongue, buccal mucosa ridging, referred pain, and limitation of mouth opening. Out of the 25 subjects who showed condylar changes, 10 subjects had symptoms of TMD. The symptoms reported are strain in the mouth opening, tenderness in jaw movements, and TMJ clicking sounds. Attrition is not a predictable sign of TMJ dysfunction, yet a finite association was defined between attrition and signs and symptoms of TMJ dysfunction. Studies involving larger samples compared with additional radiographic modalities are recommended.

A Systematic Review on Caries Detection, Classification, and Segmentation from X-Ray Images: Methods, Datasets, Evaluation, and Open Opportunities.

Dental caries occurs from the interaction between oral bacteria and sugars, generating acids that damage teeth over time. The importance of X-ray images for detecting oral problems is undeniable in dentistry. With technological advances, it is feasible to identify these lesions using techniques such as deep learning, machine learning, and image processing. Therefore, the survey and systematization of these methods are essential to determining the main computational approaches for identifying caries in X-ray images. In this systematic review, we investigated the primary computational methods used for classifying, detecting, and segmenting caries in X-ray images. Following the PRISMA methodology, we selected relevant studies and analyzed their methods, strengths, limitations, imaging modalities, evaluation metrics, datasets, and classification techniques. The review encompassed 42 studies retrieved from the Science Direct, IEEExplore, ACM Digital, and PubMed databases from the Computer Science and Health areas. The results indicate that 12% of the included articles utilized public datasets, with deep learning being the predominant approach, accounting for 69% of the studies. The majority of these studies (76%) focused on classifying dental caries, either in binary or multiclass classification. Panoramic imaging was the most commonly used radiographic modality, representing 29% of the cases studied. Overall, our systematic review provides a comprehensive overview of the computational methods employed in identifying caries in radiographic images and highlights trends, patterns, and challenges in this research field.

Automatic Assessment of Ultrasound Curvature Angle for Scoliosis Detection Using 3-D Ultrasound Volume Projection Imaging

Scoliosis is a spinal deformation in which the spine takes a lateral curvature, generating an angle in the coronal plane. The conventional method for detecting scoliosis is measurement of the Cobb angle in spine images obtained by anterior X-ray scanning. Ultrasound imaging of the spine is found to be less ionising than traditional radiographic modalities. For posterior ultrasound scanning, alternate indices of the spinous process angle (SPA) and ultrasound curve angle (UCA) were developed and have proven comparable to those of the traditional Cobb angle. In SPA, the measurements are made using the spinous processes as an anatomical reference, leading to an underestimation of the traditionally used Cobb angles. Alternatively, in UCA, more lateral features of the spine are employed for measurement of the main thoracic and thoracolumbar angles; however, clear identification of bony features is required. The current practice of UCA angle measurement is manual. This research attempts to automate the process so that the errors related to human intervention can be avoided and the scalability of ultrasound scoliosis diagnosis can be improved. The key objective is to develop an automatic scoliosis diagnosis system using 3-D ultrasound imaging. The novel diagnosis system is a three-step process: (i) finding the ultrasound spine image with the most visible lateral features using the convolutional RankNet algorithm; (ii) segmenting the bony features from the noisy ultrasound images using joint spine segmentation and noise removal; and (iii) calculating the UCA automatically using a newly developed centroid pairing and inscribed rectangle slope method. The proposed method was evaluated on 109 patients with scoliosis of different severity. The results obtained had a good correlation with manually measured UCAs (R2=0.9784 for the main thoracic angle andR2=0.9671 for the thoracolumbar angle) and a clinically acceptable mean absolute difference of the main thoracic angle (2.82 ± 2.67°) and thoracolumbar angle (3.34 ± 2.83°). The proposed method establishes a very promising approach for enabling the applications of economic 3-D ultrasound volume projection imaging for mass screening of scoliosis.

Is cone-beam computed tomography (CBCT) an alternative to plain radiography in assessments of dental disease? A study of method agreement in a medically compromised patient population

ObjectivesPoor oral health and dental infections can jeopardize medical treatment and be life-threatening. Due to this, patients with head and neck malignancies, generalized tumor spread, organ transplant, or severe infection are referred for a clinical oral and radiographic examination. The aim of this study was to compare the diagnostic agreement of three radiographic modalities: intraoral radiographs (IO), panoramic radiographs (PX), and cone beam computed tomography (CBCT) for diagnosis of dental diseases.Materials and methodsThree hundred patients were examined with IO, PX, and CBCT. Periapical lesions, marginal bone level, and caries lesions were diagnosed separately by four oral radiologists. All observers also assessed six teeth in 30 randomly selected patients at two different occasions. Kappa values and percent agreement were calculated.ResultsThe highest Kappa value and percent agreement were for diagnosing periapical lesions (0.76, 97.7%), and for the assessment of marginal bone level, it varied between 0.58 and 0.60 (87.8–89.3%). In CBCT, only 44.4% of all teeth were assessable for caries (Kappa 0.68, 93.4%). The intra-observer agreement, for all modalities and diagnoses, showed Kappa values between 0.5 and 0.93 and inter-observer agreement varied from 0.51 to 0.87.ConclusionsCBCT was an alternative to IO in diagnosing periapical lesions. Both modalities found the same healthy teeth in 93.8%. All modalities were performed equally regarding marginal bone level. In caries diagnosis, artifacts were the major cause of fallout for CBCT.Clinical relevanceIntraoral radiography is the first-hand choice for diagnosing dental disease. For some rare cases where intraoral imaging is not possible, a dedicated panoramic image and/or CBCT examination is an alternative.

Diagnostic accuracy of conventional orthodontic radiographic modalities and cone-beam computed tomography for localization of impacted maxillary canine teeth.

Orthodontic treatment planning for an impacted canine tooth requires accurate information about its position. The aim of this study was to compare the diagnostic accuracy of two conventional orthodontic radiographic modalities with cone-beam computed tomography (CBCT) for localization of impacted maxillary canine teeth. Panoramic radiographs, lateral cephalograms, and CBCT scans of 30 patients with unilaterally impacted maxillary canine teeth were retrieved from the archives. Eight expert orthodontists evaluated the parameters related to the location of impacted canine teeth by using panoramic radiographs and lateral cephalograms of patients. After 4 weeks, the same parameters were evaluated on CBCT scans of patients. The diagnostic accuracy of conventional modalities and CBCT was compared with each other and also with the gold standard. The conventional radiographic modalities and CBCT had similar accuracy for assessment of the overall inclination (p = 0.11), apex morphology (p = 0.18), and mesiodistal position of the apex (p = 0.12). CBCT had significantly higher accuracy for determination of incisal tip location (p = 0.001), labiopalatal (p = 0.001) and vertical (p = 0.01) position of the crown tip, minimum bone thickness covering the crown (p = 0.001), and root resorption of the adjacent tooth (p = 0.001). The combination of panoramic radiographs and lateral cephalograms was sufficiently accurate to assess some diagnostic parameters such as overall inclination, apex morphology, and mesiodistal apex location of impacted canine teeth.

Resolution of PIN syndrome following Physiotherapy: A case report

This case report highlights the use of physiotherapy as monotherapy for non-traumatic posterior interosseus nerve palsy, which is a rare compression neuropathy that usually gets referred to a surgeon and for which the patient may undergo surgical decompression. However, in a resource limited setting, patients are often not able to afford advanced radiographic modalities like high resolution ultrasound and MRI scans. Hence the standard pathway to surgery is uncertain and they often get referred to physiotherapy while awaiting surgery. In this case, the patient was referred for Physiotherapy and the palsy improved. This suggests there was no defined surgical lesion, as has been found in many patients who have undergone ultrasound. This case highlights the need for robust research on the role of physiotherapy for PIN palsy in resource limited settings and a possible treatment algorithm that reserves investigations and surgery for patients whose PIN palsy does not improve with physiotherapy and for whom surgery is not clearly indicated from the outset.

Soft tissue simulant materials in X-ray-based imaging in dentomaxillofacial radiology: a scoping review.

In in-vitro dental radiographic research, simulation of soft tissue is required to replicate the clinical condition as close as possible. This study aimed to find out which soft tissue simulation material have been studied to use in dentomaxillofacial radiology and showed similarity in radiodensity to the soft tissues of the maxillofacial region. In this scoping review, Web of Science, Embase, Scopus, Google scholar and PubMed databases were searched on April 9, 2023, considering the following PICOS: Population: soft tissue simulants, Intervention: X-ray-based imaging, Comparison: -, Outcome: properties of the soft tissue simulants, Study design: in-vitro studies. Screening, study selection, and data extraction were performed by two independent researchers. A third team member was consulted in the case of disagreement. Quality assessment of the included studies was made using Quality Assessment Tool For In-Vitro Studies (QUIN Tool). Of the initial 1172 articles retrieved in the database search, 13 studies were included in the review. Seven studies had a low risk of bias. In 8 studies, computed tomography (CT) or cone beam computed tomography (CBCT), in 4 studies intraoral radiography, and in 2 studies panoramic radiography was used (one study has used CT/CBCT and panoramic radiography). The studies varied in the radiographic modality, acquisition parameters, selected outcomes, and gold standard. In the majority of the studies (n = 10, 77%), acrylic resin derivatives were used in the soft tissue simulant formula alone or as a major component. Wax was used in the simulant material in 8 studies (62%). In addition, in 3 studies (23%) ice/water was used as the main simulant. Ballistic gelatin, expanded 2-cm thick polystyrene with or without 1-cm utility wax, and 0.5cm of acrylic resin were shown to have a radiographic density similar to soft tissue in standardized studies employing CBCT scanning. For intraoral radiographs, using self-polymerizing acrylic resin, utility wax, and wood, as well as a polymethylmethacrylate box filled with water in thicknesses ranging from 4 to 45mm, provides suitable radiographic contrast. However, for 4 and 8mm of wax and 4mm of water, the radiographic contrast is not appropriate. In addition, 13-17mm wax and 14.5mm acrylic resin showed acceptable soft tissue densities in intraoral radiography. Further studies using different imaging modalities with standardized conditions and objective metrics are required to confirm the most appropriate soft tissue simulant material for in-vitro dental radiographic research.

Collaborative Multi-Metadata Fusion to Improve the Classification of Lumbar Disc Herniation.

Computed tomography (CT) images are the most commonly used radiographic imaging modality for detecting and diagnosing lumbar diseases. Despite many outstanding advances, computer-aided diagnosis (CAD) of lumbar disc disease remains challenging due to the complexity of pathological abnormalities and poor discrimination between different lesions. Therefore, we propose a Collaborative Multi-Metadata Fusion classification network (CMMF-Net) to address these challenges. The network consists of a feature selection model and a classification model. We propose a novel Multi-scale Feature Fusion (MFF) module that can improve the edge learning ability of the network region of interest (ROI) by fusing features of different scales and dimensions. We also propose a new loss function to improve the convergence of the network to the internal and external edges of the intervertebral disc. Subsequently, we use the ROI bounding box from the feature selection model to crop the original image and calculate the distance features matrix. We then concatenate the cropped CT images, multiscale fusion features, and distance feature matrices and input them into the classification network. Next, the model outputs the classification results and the class activation map (CAM). Finally, the CAM of the original image size is returned to the feature selection network during the upsampling process to achieve collaborative model training. Extensive experiments demonstrate the effectiveness of our method. The model achieved 91.32% accuracy in the lumbar spine disease classification task. In the labelled lumbar disc segmentation task, the Dice coefficient reaches 94.39%. The classification accuracy in the Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) reaches 91.82%.

Development and external validation of MRI-based RAS mutation status prediction model for liver metastases of colorectal cancer.

The mutation status of rat sarcoma viral oncogene homolog (RAS) has prognostic significance and serves as a key predictive biomarker for the effectiveness of antiepidermal growth factor receptor (EGFR) therapy. However, there remains a lack of effective models for predicting RAS mutation status in colorectal liver metastases (CRLMs). This study aimed to construct and validate a diagnostic model for predicting RAS mutation status among patients undergoing hepatic resection for CRLMs. A diagnostic multivariate prediction model was developed and validated in patients with CRLMs who had undergone hepatectomy between 2014 and 2020. Patients from Institution A were assigned to the model development group (i.e., Development Cohort), while patients from Institutions B and C were assigned to the external validation groups (i.e., Validation Cohort_1 and Validation Cohort_2). The presence of CRLMs was determined by examination of surgical specimens. RAS mutation status was determined by genetic testing. The final predictors, identified by a group of oncologists and radiologists, included several key clinical, demographic, and radiographic characteristics derived from magnetic resonance images. Multiple imputation was performed to estimate the values of missing non-outcome data. A penalized logistic regression model using the adaptive least absolute shrinkage and selection operatorpenalty was implemented to select appropriate variables for the development of the model. A single nomogram was constructed from the model. The performance of the prediction model, discrimination,and calibration were estimated and reported by the area under the receiver operating characteristic curve (AUC) and calibration plots. Internal validation with a bootstrapping procedure and external validation of the nomogram were assessed. Finally, decision curve analyses were used to characterize the clinical outcomes of the Development and Validation Cohorts. A total of 173 patients were enrolled in this study between January 2014 and May 2020. Of the 173 patients, 117 patients from Institution A were assigned to the Model Development group, while 56 patients (33 from Institution B and 23 from Institution C) were assigned to the Model Validation groups. Forty-six (39.3%) patients harbored RAS mutations in the Development Cohort compared to 14 (42.4%) in Validation Cohort_1 and 8 (34.8%) in Validation Cohort_2. The final model contained the following predictor variables: time of occurrence of CRLMs, location of primary lesion, type of intratumoral necrosis, and early enhancement of liver parenchyma. The diagnostic model based on clinical and MRI data demonstrated satisfactory predictive performance in distinguishing between mutated and wild-type RAS, with AUCs of 0.742 (95% confidence interval [CI]: 0.651─0.834), 0.741 (95% CI: 0.649─0.836), 0.703 (95% CI: 0.514─0.892), and 0.708 (95% CI: 0.452─0.964) in the Development Cohort, bootstrapping internal validation, external Validation Cohort_1 and Validation Cohort_2, respectively. The Hosmer-Lemeshow goodness-of-fit values for the Development Cohort, Validation Cohort_1 and Validation Cohort_2 were 2.868 (p = 0.942), 4.616 (p = 0.465),and 6.297 (p = 0.391), respectively. Integrating clinical, demographic, and radiographic modalities with a magnetic resonance imaging-based approach may accurately predict the RAS mutation status of CRLMs, thereby aiding in triage and possibly reducing the time taken to perform diagnostic and life-saving procedures. Our diagnostic multivariate prediction model may serve as a foundation for prognostic stratification and therapeutic decision-making.

Dental Radiography in Age Determination: Contemporary Methods and Trends

The determination of an individual's age assumes paramount significance in forensic and legal contexts, necessitating the utilization of diverse techniques. Dental radiography emerges as a non-invasive approach for determining age-related dental changes. This method grants a comprehensive analysis of various dental features to identify an individual’s precise age, place them within designated age ranges, or define whether they exceed or subordinate to specific age thresholds. This review summarizes age estimation methodologies using dental radiography and conducts the investigations into contemporary trends by reviewing relevant studies published in Pubmed between 2020 and 2023. Age categorization delineates into three distinct phases: pre-natal, neo-natal, and post-natal; childhood and adolescence; and adulthood. Panoramic radiography becomes the predominant radiographic modality, with the Demirjian method is more commonly known for age estimation age in the initial two phases. In contrast, adulthood age estimation relies on anatomical changes. Significantly, artificial intelligence (AI) technology has recently attracted attention for age estimation, yielding promising results. AI demonstrates the potential to enhance the accuracy of conventional methodologies, diminishing human errors and mitigating associated workload burdens, offering inventive ground for future advancements.