Plain Radiographs Research Articles

Catfish Puncture Wound and Retained Spine Management in the ED Setting: A Case Report.

Fishing is a common recreational activity in the United States, with over 29 million registered fishers. Although not inherently dangerous, commonly seen injuries from fishing include embedded fishhooks and injury from flora and fauna. Emergency department (ED) physicians need a basic understanding of how to treat these less-than-frequent injuries. We present a case report of a patient who presented with a catfish spine lodged in her leg. These spines not only cause puncture wounds but can result in lacerations and venom release as well. Our patient presented 6 hours after the initial injury for spine removal and symptom management. Plain radiographs of the affected extremity demonstrated a 2 cm foreign body consistent with a catfish spine. The wound was expanded, and the spine successfully removed. The patient was discharged on levofloxacin and reported a healing wound without complications nearly 2 weeks after the injury.

Deep learning for symmetry classification using sparse 3D electron density data for inorganic compounds

We report a novel deep learning (DL) method for classifying inorganic compounds using 3D electron density data. We transform Density Functional Theory (DFT)-derived CHGCAR files from the Materials Project (MP) and experimental data from the Inorganic Crystal Structure Database (ICSD) into point clouds and sparse tensors, optimized for use in DL models such as PointNet and Sparse 3D CNN. This approach effectively overcomes the limitations of handling the dense 3D data, a common challenge in DL. Contrasting with traditional 1D or 2D X-ray diffraction (XRD) patterns that necessitate complex reciprocal space analysis, our method utilizes 3D density data for direct interpretation in real lattice space. This shift significantly enhances classification accuracy, outperforming traditional XRD-driven DL methods. We achieve accuracies of 97.28%, 90.77%, and 90.10% for crystal system, extinction group, and space group classifications, respectively. Our 3D electron density-based DL approach not only showcases improved accuracy but also contributes a more intuitive and effective framework for materials discovery.

Relationship between Feline Knee Joint Osteoarthritis and Bone Mineral Density Quantified Using Computed Tomography and Computed Digital Absorptiometry.

Osteoarthritis (OA), including knee joint OA, is a common chronic condition in cats. In both cats and humans, knee joint OA is characterized radiographically by the presence of osteophytes, enthesiophytes, subchondral sclerosis, and joint space narrowing. However, only in humans have these radiographic signs been reported to increase bone mineral density (BMD). Therefore, this study aims to quantify the volumetric (vBMD) and relative (rBMD) BMD measures of the feline knee joint and compare BMD measures between various severities of OA to test the hypothesized OA-BMD relationship in the knee joint in cats. The 46 feline knee joints were imaged using computed tomography (CT) and conventional radiography supported by the computed digital absorptiometry (CDA) method to obtain vBMD and rBMD, respectively. Both BMD measures were assessed in three regions of interest (ROIs): the distal femur (ROI 1), patella (ROI 2), and proximal tibia (ROI 3). In all locations, vBMD and rBMD showed moderate (ROI 2: r = 0.67, p < 0.0001) to strong (ROI 1: ρ = 0.96, p < 0.0001; ROI 3: r = 0.89, p < 0.0001) positive correlations. Due to differences (p < 0.0001) in the width of the distal femur (17.9 ± 1.21 mm), patella (8.2 ± 0.82 mm), and proximal tibia (19.3 ± 1.16 mm), the rBMD was corrected (corr rBMD) using the thickness coefficient of 0.46 ± 0.04 for ROI 2 and 1.08 ± 0.03 for ROI 3. Regardless of the quantification method used, BMD measures increased linearly from a normal knee joint to severe OA, with differences in BMD between normal and mild to severe knee joint OA. The OA-BMD relationship in the feline knee joint can be preliminarily confirmed.

3D X-ray Tomography Analysis of Mg–Si–Zn Alloys for Biomedical Applications: Elucidating the Morphology of the MgZn Phase

Temporary metal implants, made from materials like titanium (Ti) or stainless steel, can cause metabolic issues, raise toxicity levels within the body, and negatively impact the patient’s long-term health. This necessitates a subsequent operation to extract these implants once the healing process is complete or when they are outgrown by the patient. In contrast, medical devices fabricated from absorbable alloys have the advantage of being biodegradable, allowing them to be naturally absorbed by the body once they have fulfilled their role in facilitating tissue healing. Among the various absorbable alloy systems studied, magnesium (Mg) alloys stand out due to their biocompatibility, mechanical properties, and corrosion behavior. The existing literature on absorbable Mg alloys highlights the effectiveness of silicon (Si) and zinc (Zn) additions in improving mechanical properties and controlling corrosion susceptibility; however, there is a lack of comprehensive quantitative morphological analysis of the intermetallic phases within these alloy systems. The quantification of the complex morphology of intermetallic particles is a challenging task and has significant implications for the micromechanical properties of the alloys. This study, therefore, aims to introduce a robust set of morphometric parameters for evaluating the morphology of intermetallic phases within two as-cast Mg alloys with Si and Zn additions. X-ray Computed Tomography (XCT) was used to capture the 3D tomographic data of the alloys, and a novel pair of morphological parameters (ratio of convex hull to particle volume and convex hull sphericity) was applied to the 3D tomographic data to assess the MgZn phase formed in the two alloys. In addition to the impact of composition, the effect of solidification rate on the morphological parameters was also studied. Furthermore, Scanning Electron Microscopy (SEM) and Energy-Dispersive Spectroscopy (EDS) were employed to gather detailed 2D microstructural and compositional information on the intermetallics. The comprehensive characterization reveals that the morphological complexity and size distribution of the MgZn phase are influenced by both compositional changes and the solidification rate. However, the change in MgZn intermetallic particle morphology with size was found to follow a predictable trend, which was relatively agnostic of the chosen casting conditions.

The Application of Magnetic Resonance Imaging in the Early and Accurate Diagnosis of Hip Joint Avascular Necrosis.

Introduction Avascular necrosis (AVN) is characterized by the death (necrosis) of cellular bone components in the subchondral bone or epiphysis due to a lack of or an interruption of the blood supply. In routine practice, AVN is most frequently encountered in the femoral head. In this study, we aim to evaluate the application of magnetic resonance imaging (MRI) in the early and accurate diagnosis of hip joint AVN. Materials and methods This was a retrospective, cross-sectional study conducted in the Department of Radiodiagnosis of Dr. D. Y. Patil tertiary care hospital, Pimpri, Pune, India. We studied 30 patients with complaints of pain and associated limping who underwent primary radiograph analysis of the hip joint, followed by MRI. Results We assessed 30 patients (45 hip joints) using plain radiography and MRI. Of the 45 hips, we could diagnose AVN in 28 hips (62.2%) using plain radiography, but we could not diagnose it in 17 hips (37.8%), whereas we were able to diagnose AVN in all hips (100%) using MRI. Forty percent of the patients (n = 12) were on steroids, 26.7%(n = 8) were chronic alcoholics, and 16.7% (n = 5) were idiopathic. The other less common causes were a history of trauma or fracture of the neck of the femur (n = 3) and sickle cell disease (n = 2).Of the 45 hips of the 30 patients studied, 15 patients had bilateral disease affecting a total of 30 hips (66.7%), and 15 patients had unilateral disease affecting a total of 15 hips (33.4%). Of the 30 hips (bilateral disease), five (13.3%) contralateral hips were clinically occult and were incidentally diagnosed with AVN. Conclusion The assessment of AVN based solely on plain radiography can miss vital information in stages II and III (Ficat and Arlet classification). Due to its multiplanar capability, superior spatial resolution, and better tissue characterization, MRI is very sensitive and able to detect femoral head AVN early and promptly in cases that are radiograph-negative or otherwise clinically unsuspected.

A 3D micro-computed tomography study comparing embryonic skeletal development in layer versus broiler strains of the domestic chicken

Our objective was to analyze the effect of selection for divergent traits in the domestic chicken on embryonic skeletal development, which could affect postnatal bird welfare. Development was compared between the Ross 308 broiler line (fast growth and muscle mass accrual) and Novoponte layers (high laying rate and egg quality). In Study 1 (Initial Conditions), we characterized egg composition prior to incubation and identified the onset of embryonic skeletal mineralization in the 2 strains. In Study 2 (Developmental Dynamics), we used 3D X-ray tomographic imaging (µCT) on incubation days ED11, ED13, ED15 and ED17 to track skeletal maturation trajectories as a pseudo-time series. Results showed that Ross 308 embryos, which are heavier than Novoponte embryos, possess higher levels of yolk nutrients including phosphorus and calcium, but lower eggshell mineral content, than Novoponte embryos. Skeletal mineralization started synchronously in both strains, on ED11. The higher mineral ion content in the larger yolk of Ross 308 eggs compared to Novoponte eggs may partly explain why skeletal mineralization in Ross 308 embryos advances faster: using µCT, we show that the mandible and tibiotarsi in Ross 308 embryos are larger at ED11 and ED13 compared with Novoponte embryos. However, Novoponte embryos catch up from this initial lag in mineralization by ED15. The timing of the Novoponte acceleration coincides with the functional activation of the chorioallantoic membrane in releasing calcium from the inner eggshell. This correlates with a decrease in eggshell thickness from ED11 to ED17 in Novoponte eggs, which was not observed during Ross 308 incubation. To conclude, while some temporal discrepancies exist in early skeletal development between the embryos of Ross 308 and Novoponte strains, overall prenatal skeletal maturation seems to be robustly regulated. Despite selection for antagonist production traits, layer and broiler prehatch skeletal morphology ultimately synchronizes. Practically, since the extent of skeletal maturity equalizes between strains towards the end of incubation, refinements of farming practices, postnatal environment, and diet should be considered for improving domestic fowl welfare.

Dynamic plain abdominal film provides simple and effective diagnosis of delayed shunt insufficiency caused by abdominal adhesions after VP shunt

BackgroundMany complications may occur after placement of the ventriculoperitoneal shunt (VP shunt) for hydrocephalus, and delayed shunt insufficiency (DSI) is among the most common. It is often caused by abdominal adhesions, which increases the difficulty of diagnosis. This study aimed to explore the clinical value of dynamic plain abdominal radiography (DPAR) as a simple diagnostic method for patients with DSI due to terminal adhesion of the peritoneal shunt after VP surgery.MethodsA total of 30 patients with high suspicion of DSI due to abdominal adhesions after VP surgery were included. DPAR was used for prospective assessment. The interval between the first and second PAR was 4–6 h before surgery. If two plain abdominal radiography at different times indicated that the end of the shunt tube in the abdominal segment was fixed, it was diagnosed as DSI due to adhesion of the shunt tube at the abdominal end. The peritoneal end of the shunt tube was surgically repositioned. Postoperative DPAR was repeated to evaluate the distance of the shunt outlet within the abdominal segment.ResultsAll cases showed clinical symptoms or imaging findings of shunt insufficiency. The diagnostic accuracy of DPAR was 96.67% (29/30). The end of the shunt tube in the abdominal segment of the preoperative group was fixed with abdominal plain film twice with a mean difference of 1.74 ± 1.18 cm. The mean postoperative change in the position of the end of the shunt tube in the abdominal section was 9.36 ± 2.64 cm, showing a significant difference compared with the preoperative group (P < 0.001). The mean postoperative EVANs index (0.37 ± 0.08) was significantly lower than the preoperative (0.42 ± 0.08) (P = 0.007), Glasgow coma scale score (12.8 ± 2.69) was higher than the mean preoperative score (11.36 ± 2.43) (P = 0.013).ConclusionDPAR is a simple and effective method for the diagnosis of shunt insufficiency caused by delayed abdominal end adhesion after VP shunt.

A rare case of vastus intermedius tear in a middle-aged gentleman: a case report

Although quadriceps strain is fairly common, reports of isolated vastus intermedius tears are rare. We highlight the case of a middle-aged gentleman who sustained this injury when he slipped while bending down, with a 'pop' sound. Subsequently, he experienced pain, swelling, and reduced knee flexion, but was able to extend his knee fully. A plain radiograph revealed an non-displaced chip avulsion fracture of the patella, which was immobilized with an above-knee back slab. A sonogram revealed a grade 2 tear. During the acute stage, we treated the patient conservatively with progressive rehabilitation and physiotherapy. Six weeks later, the patient reported a good recovery. We admittedly considered platelet-rich plasma as an adjunct to augment the healing process of the avulsed tendon if recovery was unsatisfactory. In conclusion, vastus intermedius strains can be successfully treated conservatively with timely rehabilitation, paying attention to progress along the healing process as demonstrated in this case.

Lost &amp;amp; Found - Rediscovery of H. Hauffen’s Carychium material in the Dominik Bilimek Collection, BOKU University, including a contemporary assessment within the genus Zospeum (Gastropoda, Ellobioidea, Carychiinae)

The syntypes of Carychium reticulatum Hauffen, 1856 and Carychium bidentatum Hauffen, 1856, thought to be lost to science, have been rediscovered in a recent inventory of the shell collection of Domink Bilimek (1813–1884) at the University of Natural Resources and Life Sciences in Vienna, Austria (BOKU). In this work, we present (1) the historical context of the Dominik Bilimek and Heinrich (also: Henrik) Hauffen collections and (2) provide a contemporary image dataset of Hauffen’s original material while considering today’s taxonomic understanding of the genus Zospeum. We clarify the taxonomic status of the syntypes by using light microscopy, Scanning Electron Microcopy (SEM) and 3D X-ray Micro-CT data in conjunction with Hauffen’s original illustrations and compare them to contemporary investigations of their closest congeners. Analysis of Zospeum reticulatum (Hauffen, 1856) is supported by historical documentation from Heinrich Hauffen’s original annotations and Bilimek’s diary entries, as well as from individual collection labels in Hauffen’s own script (verified by archive material from the Archive of the National Museum of Slovenia, NMS). Hauffen’s descriptions are based on apertural morphology and shell microstructure. Our re-investigation of Zospeum reticulatum provides corroborating evidence supporting its assignment to Zospeum spelaeum (Rossmaessler, 1839) while that of Carychium bidentatum corroborates its status as junior synonym of Zospeum costatum (Freyer, 1855).

Combined exosome of adipose-derived mesenchymal stem cell and hyaluronic acid delays early osteoarthritis progression of ovine sheep model: Clinical, radiographic, macroscopic and microscopic evaluation

Background Current treatment of osteoarthritis (OA) mainly focused on treating symptoms. Exosome from Adipose-derived Mesenchymal Stem Cell (Ad-MSC) have been shown to delay degenerative process. This study aimed to investigate the clinical, radiological and histological impact of combined intra-articular (IA) hyaluronic acid (HA) and exosome Ad-MSCs in-vivo using a larger animal model with low-grade OA. Methods Eighteen male Ovies aries sheep underwent total lateral meniscectomy and conventional radiography was performed to confirm low-grade OA after 6 weeks. The sheep were divided into three groups, Group 1 (G1; n=6) received thrice exosome injections, G2 (n=6) received twice HA injection, and G3 (n=6) received both treatments with a 1-week interval after 10 days of meniscectomy. Clinical evaluations were conducted using the Clinical Lameness Score (CLS), radiographic with X-ray using OA score by Innes et al, while macroscopic evaluation by Osteoarthritis Research Society International (OARSI) scores. Results Lameness parameter scored lowest in G3 significantly (2.0±0.0 VS 2.7±0.52 VS 2.7±0.52; p=0.024) at the second month although the overall CLS score did not significantly differ at the 3rd month. The best improvement of conventional total OA radiographic score at the 3rd month compared to all groups (5.2±1.17 vs 6.3±0.82 vs 6.7±1.03; p=0.053). Macroscopic OARSI evaluation showed no difference (p=0.711). Conclusions Combined repeated exosome Ad-MSC and HA IA injection proven to delay OA progression, however longer duration of follow up is required to evaluate its long-term effect.

Fabrication and multiscale heat transfer modeling of high thermal conductivity Cf/HfB2-SiC composites

With the increasing Mach numbers of hypersonic vehicles, extreme aerothermal environments impose substantial challenges on vehicle materials. High thermal conductivity materials facilitate rapid heat redistribution to diminish localized thermal accumulation and reduce material thermal damage, providing a viable route for further enhancing the operational temperature of materials. Here, we successfully fabricate high thermal conductivity Cf/HfB2-SiC composites through the solid–liquid combination process, achieving an x-direction thermal conductivity of 161.11 W/(m·K), which represents an order of magnitude improvement over traditional carbon fiber-reinforced ultra-high temperature ceramic composites. 3D X-ray computed tomography (CT) is employed to analyze the structural composition of the high thermal conductivity Cf/HfB2-SiC composites, and the Gaussian Mixture Model is applied to segment the CT images, thus establishing a mesoscale representative volume element (RVE) model based on CT. Combining theoretical models and finite element analysis, we propose a multiscale heat transfer model for high thermal conductivity Cf/HfB2-SiC composites, which effectively investigates the heat transfer mechanisms of the composites. The fabrication and multiscale heat transfer modeling of high thermal conductivity Cf/HfB2-SiC composites provide a theoretical basis and guidance for enhancing material performance and design optimization.

Managing Pediatric Hip Pain Patients with Precision.

Pediatric hip pain can have orthopedic, infectious, inflammatory, neoplastic, or nonmusculoskeletal etiologies. Organizing the differential diagnosis by symptom chronicity and a determination of intraarticular versus extraarticular pain, as well as the age at pain onset, can be helpful to hone in on the cause. Clinicians should consider plain radiographs in cases of acute trauma, with concern for bony pathology, or in patients with unexplained limp or hip pain, with musculoskeletal ultrasound and magnetic resonance imaging used as advanced imaging when indicated. Relative rest with subsequent strengthening and stretching should be prescribed in nonoperative conditions, though several pediatric hip pain diagnoses require orthopedic or other specialty referral for definitive treatment. This article is a comprehensive review of hip pain etiologies in the pediatric population.

Hip Injuries in the Pediatric Athlete—Pelvic Apophyseal Avulsions

Pelvic apophyseal avulsion fractures have been occurring more commonly in young athletes in the context of increased intensive year-round training and early specialization in youth sports, and this diagnosis must be considered in the pediatric patient presenting with hip pain. An understanding of the relevant anatomy can guide the history and physical exam to arrive at the diagnosis, which is usually confirmed with plain radiographs. Although non-operative management remains the mainstay of treatment for these patients, surgery may be warranted for ischial tuberosity fractures displaced > 2 cm and for symptomatic nonunions The objective of this review is to provide a comprehensive overview of pelvic apophyseal avulsion injuries.

Development and validation of deep learning models for bowel obstruction on plain abdominal radiograph.

Artificial intelligence (AI) could help medical practitioners in analyzing radiological images to determine the presence and site of bowel obstruction. This retrospective diagnostic study proposed a series of deep learning (DL) models for diagnosing bowel obstruction on abdominal radiograph. A total of 2082 upright plain abdominal radiographs were retrospectively collected from four hospitals. The images were labeled as normal, small bowel obstruction and large bowel obstruction by three senior radiologists based on comprehensive examinations and interventions within 48 hours after admission. Gradient-weighted class activation mapping was used to visualize the inferential explanation. In the validation set, the Xception-backboned model achieved the highest accuracy (0.863), surpassing the VGG16 (0.847) and ResNet models (0.836). In the test set, the Xception model (accuracy: 0.807) outperformed other models and a junior radiologist (0.780) but not a senior radiologist (0.840). In the AI-aided diagnostic framework, the junior and senior radiologists made their judgements while aware of the Xception model predictions. Their accuracy significantly improved to 0.887 and 0.913, respectively. We developed and validated DL-based computer vision models for diagnosing bowel obstruction on plain abdominal radiograph. DL-based computer-aided diagnostic systems could reduce medical practitioners' workloads and improve diagnostic accuracy.

High-precision and non-invasive measurement of crestal bone level by optical coherence tomography

Background/purposeIdentifying crestal bone level (CBL) on the buccal and lingual aspects poses challenges in conventional dental radiographs. Given that optical coherence tomography (OCT) has the capability to non-invasively provide in-depth information about the periodontium, this in vitro study aimed to assess whether OCT can effectively identify periodontal landmarks and measure CBL in the presence of gingiva. Materials and methodsAn in-house handheld scanning probe connected to a 1310-nm swept-source OCT (SS-OCT) system, along with self-developed algorithms were employed to measure the CBL in dental models with artificial gingiva. Markers were positioned 0.5 mm above the artificial gingival margin (SG) and the crestal bone (SC) on both the mid-buccal and mid-lingual sides of 28 plastic teeth. The distances between the paired SG and SC were measured in the OCT images after correcting for the optical path through the covering artificial gingiva. These measurements were subsequently compared to the ground truth values obtained using a 2.5D inspection system. ResultsThe mean difference in CBL measured by SS-OCT and 2.5D was 0.008 mm (95 % CI: −0.092 to 0.108 mm). Statistical analysis using a three-way ANOVA indicated that the measurement differences were not significant across maxillary/mandible, anterior/posterior, and buccal/lingual dimensions. Furthermore, these differences were not associated with gingival thickness (α = 0.05). ConclusionThe proposed SS-OCT system demonstrated its capability to accurately and non-invasively assess CBL through artificial gingiva. Moreover, it facilitated the semi-automatic delineation of critical periodontal landmarks on OCT en face images, highlighting its potential for clinical applications.

Longitudinal observation of distal tibial degeneration in varus ankle osteoarthritis using plain radiograph

BackgroundThis study aimed to explore the natural history of distal tibial deformity in varus ankle osteoarthritis and to identify risk factors for its progression. MethodsThis retrospective longitudinal observational study included 97 ankles with moderate to severe varus ankle osteoarthritis, monitored for > 2 years. Radiographic assessments were conducted on weightbearing plain radiographs at the initial and final visit. ResultsSignificant tibial anterior surface angle reduction (p = 0.008), talus center medial migration (p = 0.038), and tibial lateral surface angle increase (p = 0.034) occurred. Multiple logistic analysis revealed an association between progression and coronal talar tilt angle at the first visit (odds ratio 1.17, p = 0.015) ConclusionThe progression of radiographic distal tibial deformity in varus ankle osteoarthritis was clarified, identifying the coronal talar tilt angle as a risk factor. Level of EvidenceLevel IV, retrospective longitudinal observation study

Evaluation of the Dysfunctional Scapula.

Periscapular pain and dysfunction are relatively common complaints in the practice of upper extremity surgeons. However, evaluation of the dysfunctional scapula is intimidating for most. Physical examination of the periscapular muscles is very rich, and a systematic approach provides the opportunity to establish a diagnosis for most patients. Conditions underlying scapular dysfunction include trapezius palsy, serratus palsy, brachial plexus injuries, muscular dystrophy, snapping scapula, pectoralis minor syndrome, congenital undescended scapula, and functional scapular dyskinesis, among others. Patients should be examined with their torso uncovered and assessed from the front and back. Inspection, evaluation of motion, and strength testing may be followed by certain examination maneuvers specific for each condition. The scapular assistance test may help predict the outcome of treatment for certain conditions. Plain radiographs oftentimes need to be complemented with magnetic resonance of the chest to capture periscapular muscles as well as an electromyogram with nerve conduction studies. Computed tomography is particularly helpful for skeletal abnormalities. Ultrasound is used to assess certain peripheral nerve injuries and to guide diagnostic and therapeutic injections. A focused evaluation of the scapula followed by a more specific and directed approach for each condition suspected will allow upper extremity surgeons to approach the evaluation of the dysfunctional scapula with much more confidence.

Development and validation of deep learning models for identifying the brand of pedicle screws on plain spine radiographs.

In spinal revision surgery, previous pedicle screws (PS) may need to be replaced with new implants. Failure to accurately identify the brand of PS-based instrumentation preoperatively may increase the risk of perioperative complications. This study aimed to develop and validate an optimal deep learning (DL) model to identify the brand of PS-based instrumentation on plain radiographs of spine (PRS) using anteroposterior (AP) and lateral images. A total of 529 patients who received PS-based instrumentation from seven manufacturers were enrolled in this retrospective study. The postoperative PRS were gathered as ground truths. The training, validation, and testing datasets contained 338, 85, and 106 patients, respectively. YOLOv5 was used to crop out the screws' trajectory, and the EfficientNet-b0 model was used to develop single models (AP, Lateral, Merge, and Concatenated) based on the different PRS images. The ensemble models were different combinations of the single models. Primary outcomes were the models' performance in accuracy, sensitivity, precision, F1-score, kappa value, and area under the curve (AUC). Secondary outcomes were the relative performance of models versus human readers and external validation of the DL models. The Lateral model had the most stable performance among single models. The discriminative performance was improved by the ensemble method. The AP + Lateral ensemble model had the most stable performance, with an accuracy of 0.9434, F1 score of 0.9388, and AUC of 0.9834. The performance of the ensemble models was comparable to that of experienced orthopedic surgeons and superior to that of inexperienced orthopedic surgeons. External validation revealed that the Lat + Concat ensemble model had the best accuracy (0.9412). The DL models demonstrated stable performance in identifying the brand of PS-based instrumentation based on AP and/or lateral images of PRS, which may assist orthopedic spine surgeons in preoperative revision planning in clinical practice.

Diagnostic and Therapeutic Approach to Thoracic Outlet Syndrome.

Thoracic outlet syndrome (TOS) is a group of symptoms caused by the compression of neurovascular structures of the superior thoracic outlet. The knowledge of its clinical presentation with specific symptoms, as well as proper imaging examinations, ranging from plain radiographs to ultrasound, computed tomography and magnetic resonance imaging, may help achieve a precise diagnosis. Once TOS is recognized, proper treatment may comprise a conservative or a surgical approach.

Radiology of malignant cervical adenopathy

Imaging of neck and skull base has significantly improved the diagnosis and management of neck conditions. Prior to the use of CT, MRI and PET imaging, the value of plain radiographs of the neck was limited. Today, modern imaging techniques are an essential adjunct to the physical examination of the neck, can confidently limit the differential, and in many clinical scenarios yield a specific diagnosis. In addition, the value of imaging cannot be understated in surgical planning and surveillance. This article will review the techniques used in neck lymph node imaging and cover several of the most common conditions that result in malignant lymphadenopathy in the neck.