Radiographic Modalities Research Articles

CORRELATION BETWEEN FINE NEEDLE ASPIRATION CYTOLOGY AND CORRESPONDING ULTRASOUND BIRADS SCORE IN MAMMARY MALIGNANCY

The aim of this study is to evaluate accuracy of ultrasound in diagnosing breast cancer and assessing correlation of radiological findings with findings of fine needle aspiration cytology (FNAC). Retrospective study was conducted at IbneSina Hospital& Multan Medical & Dental College Multan from July 2021 to December 2021. Study was conducted on 40 patients aged between 30 to 90 years having breast limps. Subjects underwent clinical and ultrasonic examination and BIRADS score was correlated with cytology data. Major ultrasonic finding was that irregular lesion was found in 21 (52.5%) subjects. In 10 (25%) patientsill defined lesion was found. FNAC revealed severe atypia in 7.5% and mammary carcinoma in 92.5% cases.BIRADS score V, IV and III were assigned to 75%, 20% and 5% cases respectively. Correlation of FNAC results with ultrasonic findings showed 90.6% accuracy of ultrasound in diagnosis of breast cancer. Ultrasonography provides accurate diagnosis of breast lesions and is recommended radiographic modality for assessing underlying cause of palpable breast mass.

CONSIDERATIONS OF MULTI-IMAGING MODALITIES FOR DIAGNOSING OF SIALOLITHIASIS IN THE SUBMANDIBULAR GLAND: A CASE REPORT

Introduction: Sialolithiasis is a condition that occurs due to obstruction in the salivary gland or ductus excretory by calculus or sialolith. Sialolithiasis was the most common disease of salivary glands with a percentage of about 50%, and approximately 80-90% occurs in the submandibular gland. This paper analyzes the sialolithiasis in the submandibular gland being reviewed from the radiograph. Radiography screening becomes one of the most essential supporting examinations to help enforce the diagnosis and treatment plan to be conducted.Case : A 33-year-old patient was seen in Oral and Maxillofacial Surgery of General Hospital, Bandung, Indonesia. The chief complaint of swelling in the right side of his lower jaw was under the chin. Multi-imaging and radiography modalities screening were panoramic, occlusal, cervical, CT Scan, USG, and sialography. Case management : On radiographic examination, radiological suspicion was sialolithiasis with a well-defined and irregularly shaped radiopaque lesion in the lower right jaw area. Therefore, radiographic techniques with different modalities were performed to support each other in delivering accurate radiodiagnosis. Conclusion: The considerations of using appropriate multi-imaging and radiographic modalities are necessary to confirm the diagnosis of sialolithiasis in the submandibular salivary glands, especially in hard-recognized cases on plain radiographs. Keywords: Radiography, Sialolithiasis, Submandibular gland

62 Multicenter validation of the C-3PO rule to identify young children at risk of skull fracture following head trauma

Abstract Background There is no widely accepted clinical tool to safely predict skull fracture in young children who sustained a head trauma. The C-3PO rule is a clinical decision rule which reported that age up to 3 months, or parietal/occipital scalp hematoma are predictors of skull fracture in young children. Objectives The present study prospectively evaluated the C-3PO rule in multiple new settings. Design/Methods This was a prospective multi-centre observational study conducted in three tertiary Emergency Departments (ED) in Canada and Switzerland. Patients were included if they were up to the age of 24 months of age and had a head trauma without high risk factors for clinically important intracranial injury according to the PECARN head trauma rule. The primary outcome was a radiologically identified skull fracture identified by any radiographic imaging modalities. The independent variables were the three components of the C-3PO rule as assessed by the treating physician. The patients were treated as per the physician’s discretion and followed up by phone if there was no initial skull radiological imaging. Criterion validity of the rule was calculated. Results A total of 844 patients were included with a median age of 8 months. Thirty percent of these patients (n=263) received radiological imaging, and 52 (6.2%) patients had a skull fracture. The C-3PO rule identified 51/52 children with a fracture for a sensitivity of 98% (95% CI: 90-100%), and a specificity of 70% (95% CI: 67-74%). Applying the rule would have reduced radiological imaging from 263 to 211 patients (-20%; 95%CI: 15-25%). Conclusion The C-3PO rule can safely be applied by pediatric emergency physicians evaluating children younger than 24 months with a head trauma. It helps ED clinicians to identify young children at low risk for skull fracture, improving decision making regarding the use of CT scan for children at intermediate risk of clinically important traumatic brain injury.

A Proposal for a Standardized Imaging Algorithm to Improve the Accuracy and Reliability for the Diagnosis of Thoracolumbar Posterior Ligamentous Complex Injury in Computed Tomography and Magnetic Resonance Imaging.

Systematic Literature Review. To propose a systematic imaging algorithm for diagnosing posterior ligamentous complex (PLC) injury in computed tomography (CT) and magnetic resonance imaging (MRI) to improve the reliability of PLC assessment. A systematic review was conducted following PRISMA guidelines. The Scopus database was searched from its inception until July 21, 2022, for studies evaluating CT or MRI assessment of the PLC injury following thoracolumbar trauma. The studies extracted key findings, objectives, injury definitions, and radiographic modalities. Twenty-three studies were included in this systematic review, encompassing 2021 patients. Five studies evaluated the accuracy of MRI in detecting thoracolumbar PLC injury using intraoperative findings as a reference. These studies indicate that black stripe discontinuity due to supraspinous or ligamentum flavum rupture is a more specific criterion of PLC injury than high-signal intensity. Thirteen papers evaluated the accuracy or reliability of CT in detecting thoracolumbar PLC injury using MRI or intraoperative findings as a reference. The overall accuracy rate of CT in detecting PLC injury was 68-90%. Two studies evaluate the accuracy of combined CT findings, showing that ≥2 CT findings are associated with a positive predictive value of 88-91 %. Vertebral translation, facet joint malalignment, spinous process fracture, horizontal laminar fracture, and interspinous widening were independent predictors of PLC injury. We provided a comprehensive imaging algorithm for diagnosing PLC in CT and MRI based on available literature and our experience. The algorithm will potentially improve the accuracy and reliability of PLC assessment, however it needs multicentre prospective validation.

Imaging for dental implant therapy, what do Palestinian dentists prefer?

Aim: To report the radiographic modalities preferred during dental implant therapy in Palestine. Material and methods: fourteen multiple-choice questions were delivered in electronic and hardcopy formats questionnaires during the sixth international implantology conference (Palestine). The questions mainly investigated the radiographic techniques that are mostly used based on various clinical scenarios and treatment phases. Results: One hundred and thirty-seven responses were captured. The majority of the participants were general dentists with implant experience (79.6%). Less than a third of the participants (27.2%) were members of the Palestinian Association of Dental Implantology. The majority (85.9%) of them have their practice in a city zone. Panoramic radiograph (PAN) combined with Cone Beam Computed Tomography (CBCT) was the most preferred radiographic technique during the planning stage. PAN as a single examination was the most preferred radiograph directly after the implant surgery and during the follow up of Asymptomatic patients. The majority of the participants believe that three-dimensional techniques provide additional anatomical details essential for the success of the implant treatment. Conclusion: Panoramic radiograph and CBCT was the preferred choice during the planning stages of dental implants.

Correlation of radiomorphometric indices of the mandible and mandibular angle fractures

This study assessed the correlation of radiomorphometric indices of the mandible and mandibular angle fractures (MAFs) in an Iranian population. This retrospective study was conducted on 3D computed tomography (CT) scans of 118 patients between 18 to 60 years. The images were divided into two groups with MAFs and other types of mandibular fractures (non-MAF). The gonial angle, ramus height, condylar neck width, minimum ramus width, and mandibular length were all measured using MARCO PACS software. Age, gender, and presence and eruption status of third molar at the fracture side were all recorded. The correlation between these parameters and MAF was analyzed using R software (alpha = 0.05). Of all patients, 41 samples had MAF. The two groups were not significantly different regarding the mean age and gender (P > 0.05). The mean size of gonial angle and ramus height in the MAF group were significantly larger, and smaller than the corresponding values in the non-MAF group, respectively (P < 0.001). The median minimum ramus width in the MAF group was significantly smaller than that in the non-MAF group (P = 0.001). Patients with a large gonial angle had 6.6 times higher odds of MAF compared with other fracture types (P = 0.046). Condylar neck width, mandibular length, and erupted third molars had no significant correlation with type of fracture. Presence of impacted third molar increased the odds of MAF by 5.55 times.Patients with a large gonial angle, short ramus height, minimum ramus width, and impacted third molar are more susceptible to MAF. Surgeons can use these indices to predict the risk of MAF in trauma patients with such facial characteristics, and make a diagnosis by radiographic modalities.

Respiratory morbidity in children with tracheoesophageal fistula

: Tracheoesophageal fistula (TEF) is a common congenital anomaly of the respiratory tract that can be isolated or associated to malformations of the digestive tract. The defective lateral septation of the foregut during the embryonic period is the most commonly accepted pathogenic hypothesis. Respiratory morbidity may recognize multiple aetiologies in TEF affected children. Indeed, associated airway abnormalities, tracheomalacia and bronchomalacia, airways hyperreactivity, iatrogenic laryngeal nerve damage and gastroesophageal reflux (GER) contribute to the onset of respiratory complaints. Symptoms onset (cough and cyanosis during feeding, barky cough, wheeze, asthma on exertion, inhalation pneumonia) is variable and the diagnosis is often not straightforward. Combined flexible bronchoscopy and digestive endoscopy are the main diagnostic modalities, supplanted by radiographic modalities especially CT scans of the chest. Fistula ligation or endoscopic repair by using tissue or fibrin adhesive are commonly employed. Because of the association of TEF with abnormalities involving other organs and systems, a multidisciplinary approach should be considered in the management of children with TEF. Although respiratory problems are more frequent during childhood, they tend to persist into adulthood. Therefore, transition of care from paediatric to adult services is imperative.

Identification of avian remains contained within wrapped ancient Egyptian mummies: Part 1, A critical assessment of identification techniques

Ancient Egyptian bird mummies manufactured in huge numbers present a unique and intriguing body of material with great archaeological and zooarchaeological significance. Research into this ancient practice is gaining momentum; however, one area that lacks clarity, but that is vital for the accurate interpretation of mummies as objects of ritual significance, is our ability to proffer accurate identifications of remains contained within wrapped mummy bundles. This is particularly relevant in the case of bird mummies where morphological variation between species can be minimal.This paper presents the results of a multi-faceted research project combining non-invasive radiographic modalities, experimental techniques and 3D replication, designed to assess the accuracy of avian skeletal identification when physical access to the bones themselves is not possible.

The role of radiology in risk assessment and management of oroantral fistula and displaced roots

AbstractThere is a weak evidence base on which to define the most appropriate radiographic technique to evaluate dental tissues that may impact on the maxillary sinus, including the risk assessment for oroantral communications, identification and removal of displaced roots, timing and optimal management of oroantral fistula, in the presence of odontogenic sinusitis. There is no demonstrable benefit from the routine use of CBCT in exodontia. However, cross‐sectional imaging is strongly recommended over 2‐dimensional radiographic techniques when identifying displaced roots of teeth, and during surgical management of oroantral fistulae, particularly when considering the incidence of extra‐maxillary disease in odontogenic sinusitis. In this narrative review, using the limited evidence available, and relying on clinical experience, we adopt a risk–benefit analysis for the optimal use of various radiographic imaging modalities from pre‐operative assessment to management of complications, focusing on patient outcomes.

A case report and literature review of an intrathyroid epidermoid cyst

Epidermoid cysts are the most common cutaneous cysts, and infrequently develop within mucosal or glandular tissue. Rarely, epidermoid cysts have been described as arising within the thyroid gland in the form of a nodule. In this paper, we describe a case of a 72-year-old female with a suspicious-appearing thyroid nodule on ultrasound, which was eventually found to be an epidermoid cyst. To our knowledge, this is the first surgical biopsy-proven case that demonstrates an intrathyroid epidermoid cyst in multiple radiographic modalities including ultrasound, nuclear medicine I-123 thyroid scan, and MRI. In addition, we present a concise review of previously described cases of intrathyroid epidermoid cysts, including patient clinical manifestations, initial sonographic appearance, and management of lesions. This case reinforces the importance of considering rare diagnoses in the workup of a thyroid nodule based on its sonographic appearance.

Pancreaticoduodenectomy for pancreatic adenocarcinoma in a patient with situs inversus abdomenalis, a case report.

Introduction and importanceSitus Inversus (SI) is a rare congenital condition in which the abdominal and thoracic organs are located in a mirror image of the normal position in the sagittal plane. Although this condition does not affect normal health or longevity, its recognition is very important for treating many diseases, particularly those requiring surgical intervention. The relationship between situs inversus and cancer remain inconspicuous.Case presentationWe report a 64-year old male with Situs Iinversus Abdominalis with Pancreatic Adenocarcinoma. Radiographic modalities were very important in preoperative assessment of the patient. The patient was managed by pyloric preserving pancreaticoduodenectomy. The patient received adjuvant chemotherapy and free of recurrence for one year after operation.ConclusionSurgeons must recognize the complexity of operative intervention with respect to aberrant anatomy. The occurrence of Situs Inversus in a patient with pancreatic cancer must not deter the surgeon from sound oncologic principles of pancreatic surgery. Referral to these cases to tertiary level center is of utmost importance.

DMDF-Net: Dual multiscale dilated fusion network for accurate segmentation of lesions related to COVID-19 in lung radiographic scans

The recent disaster of COVID-19 has brought the whole world to the verge of devastation because of its highly transmissible nature. In this pandemic, radiographic imaging modalities, particularly, computed tomography (CT), have shown remarkable performance for the effective diagnosis of this virus. However, the diagnostic assessment of CT data is a human-dependent process that requires sufficient time by expert radiologists. Recent developments in artificial intelligence have substituted several personal diagnostic procedures with computer-aided diagnosis (CAD) methods that can make an effective diagnosis, even in real time. In response to COVID-19, various CAD methods have been developed in the literature, which can detect and localize infectious regions in chest CT images. However, most existing methods do not provide cross-data analysis, which is an essential measure for assessing the generality of a CAD method. A few studies have performed cross-data analysis in their methods. Nevertheless, these methods show limited results in real-world scenarios without addressing generality issues. Therefore, in this study, we attempt to address generality issues and propose a deep learning–based CAD solution for the diagnosis of COVID-19 lesions from chest CT images. We propose a dual multiscale dilated fusion network (DMDF-Net) for the robust segmentation of small lesions in a given CT image. The proposed network mainly utilizes the strength of multiscale deep features fusion inside the encoder and decoder modules in a mutually beneficial manner to achieve superior segmentation performance. Additional pre- and post-processing steps are introduced in the proposed method to address the generality issues and further improve the diagnostic performance. Mainly, the concept of post-region of interest (ROI) fusion is introduced in the post-processing step, which reduces the number of false-positives and provides a way to accurately quantify the infected area of lung. Consequently, the proposed framework outperforms various state-of-the-art methods by accomplishing superior infection segmentation results with an average Dice similarity coefficient of 75.7%, Intersection over Union of 67.22%, Average Precision of 69.92%, Sensitivity of 72.78%, Specificity of 99.79%, Enhance-Alignment Measure of 91.11%, and Mean Absolute Error of 0.026.

Xerostomia Diagnosis – A Narrative Review

Xerostomia can be defined as a feeling of dryness of mouth, which may or may not be accompanied with reduced salivary secretions. Xerostomia may result in localized and systemic disturbances within the body. The overall global prevalence of xerostomia is 22% with wide variation among different countries due to difference in target population. This review presents the recent literature on the diagnostic methodologies that are present in recent times through subjective and objective corridors. The most commonly used subjective methods for the xerostomia diagnosis include: Fox questionnaire, Visual Analogue Scale (VAS), Xerostomia Inventory (XI), and Shortened Xerostomia Inventory (SXI). Objective xerostomia diagnostic tools include salivary flow rate assessment. Aside from this, there are numerous radiographical modalities that can be used especially in diagnosing salivary gland disorders or radiation exposure due to oncological treatments which can also provide the added information to diagnose or monitor xerostomia. These radiographic tools include computer tomography (CT), scintigraphy, sialography, magnetic resonance imaging (MRI), and ultrasonography. Different combination of tools gives a better xerostomia assessment, selection of which also depends on the age and health condition of the patient. KEYWORDS: flow rate; hyposalivation; diagnosis; oral dryness; salivary gland dysfunction

Applications of cone beam computed tomography in the field of prosthodontics: A review

Cone beam computed tomography (CBCT) is one of the latest radiographic modality available. It is use are enormous in medical and dental field. Among all CBCT is an essential commodity in the field of prosthodontics. The amazing capability of CBCT for providing sub-millimeter resolution in images of high diagnostic quality, with short scanning times (10–70 s) and radiation dosages reportedly up to 15–100 times lower than those of conventional Computed tomography scans are the unique features of CBCT. The aim of this article is to educate the Prosthodontist to CBCT technology, provide an overview of CBCT systems and review the specific application of various CBCT display modes to clinical Prosthodontics practice.

Different radiographic imaging modalities with a proton computed tomography demonstrator

Proton computed tomography aims at improving proton-beam therapy, which is an established method to treat deep-seated tumours in cancer therapy. In treatment planning, the stopping power (SP) within a patient, describing the energy loss of a proton in a tissue, has to be known with high accuracy. However, conventional computed tomography (CT) returns Hounsfield units (HU), which have to be converted to SP values to perform the required treatment planning, thus introducing range uncertainties in the calculated dose distribution. Using protons not only for therapy but also for the preceding planning CT enables the direct measurement of the SP. Hence, this imaging modality eliminates the need for further conversion and therefore offers the possibility to improve treatment planning in proton therapy. In order to examine the principles of such a proton CT (pCT) setup, a demonstrator system, consisting of four double-sided silicon strip detectors and a range telescope, was built. The performance of the pCT demonstrator was tested with measurements at the MedAustron facility in Wiener Neustadt, Austria. In this paper, 2D imaging modalities going beyond the idea of a standard proton radiography, will be discussed. Namely, fluence loss imaging and scattering radiography results obtained with the demonstrator will be shown. The advantage of these modalities is that they do not rely on an additional energy measurement and can therefore be conducted only with the tracker of the demonstrator.

A Computational Approach to 3-Dimensional Reconstruction Image of Diabetic Foot using the Near-Infrared Spectroscopy (NIRS) after Magnetic Field Intensity Stimulation: Preliminary Study

Diabetes Mellitus (DM) or Diabetes is a disease characterized by a high sugar level in the blood. The foot is considered as a distinct entity where most of the complication arises that often leads to lower extremity amputation. Recently, the Pulse Magnetic Field (PMF) devices that use magnetic field intensity as stimulants are being used to improve blood circulation among patients with peripheral vascular diseases (PVD). This study promotes the use of Near-Infrared Spectroscopy (NIRS) devices in diagnosing and monitoring DM after the use of PMF devices by providing a piece of biomedical evidence through a simulation approach on how to reconstruct a 3-dimensional biological tissue shape models. The result showed that this simulation approach could be of use in the actual reconstruction of a diabetic foot showing the absorption coefficient. NIRS device and the biomedical images could be of use in places where radiographic imaging modalities are not accessible.

Role of Imaging in Dental Implantology: A Review

Dental radiography has long been a fascinating and useful diagnostic tool in the field of dentistry with the ever-increasing number of imaging modalities this has never been more true. The only sort of (non-surgical) bone examination necessary for implant therapy is radiography. The decision to image and which imaging modalities to utilize is dependent on several variables, including identifying the quality and amount of bone in order to decide the optimal position for implant placement, detecting the presence or absence of pathosis, and patient availability at a reasonable expense. Furthermore, while selecting radiographic examinations, it is critical to reduce patient exposure to radiation to a minimum. This article reviews current implant planning concepts utilizing various radiographic modalities, as well as their application to enhance the clinician's role in efficient implant placement. The importance of pre-surgical treatment planning for successful implant therapy cannot be overstated. In this case, diagnostic imaging is critical. Various imaging techniques are accessible to help in the placement of the implant in the correct position with respective facility and predictability. Among the modalities referenced are intraoral radiography, panoramic radiography, computed tomography and cone beam CT. The use of CBCT is utilized by the specialist to outline the method of the course of nerves in the jawbone and to decide the legitimate insert length. Inserts ought not be embedded into the sinuses. The vicinity of maxillary sinus may be accurately seen with CBCT. The surgeon can take exact measurements and pick the optimal implant length to prevent puncturing the maxillary sinus. For the optimal support, the right implant size can be chosen. The surgeon can use CBCT to analyze the accessible bone and select the dimensions that are suitable for the region. The CBCT programming produces improved picture, oblique and curved planar reorganization. Furthermore, minimizing the patient's radiation dosage during radiographic testing should always be a primary priority.

An investigation of radiographers' and radiologists' perceptions and attitudes in Kuwait towards extending radiographers’ role in mammography

IntroductionKuwait has a shortage of radiologists, especially in mammography, resulting in increased workload and longer waiting times for women receiving imaging investigations. This study looked at how radiographers and radiologists perceived radiographers’ role extension (RE) in mammography, and whether this could reduce radiologist workload, thereby improving patient service and waiting times. MethodsA single case study design with 10 radiographers (mammographers) and 10 radiologists was undertaken across multiple sites: hospitals, screening clinics and specialist centres in Kuwait. Data included individual semi-structured interviews, documentary analysis and field notes. Perceptions were examined under a theoretical framework, Abbotts’ System of Professions. ResultsTwo main themes were identified, firstly in examining the current role of radiographers in mammography and areas of interest for extending role, this highlighted insufficient knowledge of the concept. The second focused on in-depth understanding of drivers and barriers to RE in mammography, both groups opposed radiographers performing extended tasks without radiologist supervision. ConclusionRadiologists and radiographers' attitudes were influenced by concepts of professional identity and professional identity formation. Insufficient professional knowledge negatively affected the radiographers' readiness to undertake RE in mammography. Radiologists are reluctant to blur boundaries, enabling them to maintain and control jurisdiction of their own profession and that of radiographers, thereby, as discussed in Abbott's theory, limiting impact on workload or waiting times. Implications for practiceWhilst RE is limited, to improve workload and patient waiting times, setting up an educational programme for radiographers specialising in mammography would be an important step to extending the radiographers' role. The study highlighted a need to educate radiographers to undertake breast ultrasound and amend policy to introduce training programmes for radiographers. Radiographer rotation across the various radiographic modalities negatively affected radiographers’ performance, placing well-trained radiographers permanently within the mammography department should improve experience and overall skills.

Have conventional dental radiographs lost its charm to modern techniques?

For any dental implant procedure that is being carried out, the success will depend on a thorough pre-operative investigation. The quality, quantity and the volume of available bone at the planned implant site has to be assessed properly when planning a dental implant placement. When we speak of the fore-mentioned aspects pre-surgical imaging and its co-relation to clinical findings help assess the relation to the amount of bone available from underlying vital parts namely the sinus cavities, nasal floor, nerves, teeth and vessels. Different radiographic modalities have been advocated for its assessment. Intra Oral Peri-apical radiograph (two-dimensional) is one such modality that has lost its importance after the introduction of more advanced techniques like Cone Beam Tomography (three-dimensional). This article will help us understand how two-dimensional and three-dimensional imaging modalities go hand in hand while treating dental patients. It will also explain why the conventional imaging technologies are still required in this era of modern methods of imaging.

Radiographic imaging in relation to the mandibular third molar: a survey among oral surgeons in Sweden

ObjectivesTo query the experience of oral surgeons concerning referral routines and preferences for radiographic imaging modality before surgical removal of mandibular third molars and investigate factors that influence imaging modality preferences.Materials and methodsMembers of the Swedish Association of Oral and Maxillofacial Surgeons (n = 280) were invited to participate in a web-based digital survey concerning their experiences and use of three imaging modalities in pre-surgical assessment of mandibular third molar removal. The survey comprised multiple-choice questions and four cases depicted in images; respondents reported whether they would supplement the cases with other images and, if so, from which modality.ResultsThe response rate was 64%. Panoramic radiographs were most commonly used in pre-surgical planning (response options: always or often), significant difference between professions (p = 0.039), and considered to facilitate treatment planning (87%), as was CBCT (82%); for 51%, CBCT reduced post-operative complications. Preferred modality for localizing the mandibular canal was fairly evenly distributed and for non-complex case, significant difference between subgroups of OMFS surgeons was found (p = 0.003) as to preference for intraoral radiographs.ConclusionsA majority of respondents received a report within 2 weeks of their referral for CBCT and would read the report and view the images before surgery. Image modality preference differed depending on case complexity, with a greater perceived need for CBCT. Profession and practical experience affected choice.Clinical relevanceChoice of imaging modality in mandibular third molar assessment is also important from dose delivery and social economy standpoints.