Radiographic Views Research Articles

Imaging characteristics of too-long anterior process syndrome in children and adolescents.

In the presence of pain over the lateral aspect of the foot or recurrent ankle sprain in children, medical imaging is often employed to investigate potential causes, such as a calcaneonavicular coalition or a too-long anterior process (TLAP) of the calcaneus. Diagnosis and categorization of calcaneonavicular coalitions (synostosis, synchondrosis, or synfibrosis) is generally facilitated through imaging, in contrast to TLAP, which lacks well-defined semiological characteristics, apart from a calcaneonavicular space measurement of less than 5 mm. However, this measurement initially performed on an oblique view radiograph can be subject to a lack of precision due to positional variations of the foot and overlappingbones. Furthermore, the differentiation between TLAP as an anatomical variant and TLAP syndrome (characterized by symptomatic presentation), remains a subject of uncertainty. The objective of our retrospective study was to investigate the imaging diagnosis of TLAP syndrome. A retrospective unmatched case-control study was conducted, covering data from February 2014 to January 2021. All patients, included retrospectively and consecutively, were initially managed in our hospital with radiography and/or computed tomography (CT) and/or magnetic resonance imaging (MRI). Two radiologists independently reviewed the images taken (radiographs, CT scans, and MRIs) of patients undergoing treatment in pediatric orthopedics for TLAP syndrome and control subjects, utilizing a standardized questionnaire. The control group consisted of subjects with no features suggestive of TLAP syndrome. The questionnaire included measurements of the calcaneonavicular space and identification of indirect signs associated with calcaneonavicular coalitions, as described in the related literature. A total of 128 patients who met the inclusion criteria were included in the analysis, including 38 patients and 90 controls. The prevalence of TLAP was 71.5% in the study population and 62.6% among controls. A threshold measurement of the calcaneonavicular space at 3.2 mm favored TLAP syndrome (sensitivity=97%, specificity=70%, area under the curve [95% confidence interval] =0.881[0.812-0.949]), with better precision using CT. Three indirect signs were significant: the "anteater nose" sign, the talar beak, and the tapered anterior calcaneal process. These signs demonstrated an even stronger association with TLAP syndrome when observed in conjunction with a reduction in the calcaneonavicular space, particularly in CT scans. TLAP is common among control subjects. Therefore, a variant appears to be the most plausible explanation and it can be considered a mild form of calcaneonavicular coalition. However, in conjunction with symptoms suggestive of TLAP syndrome, the diagnosis is further supported by imaging, specifically with a calcaneonavicular space measurement of less than 3.2 mm. This measurement is most accurately obtained using CT with 2-dimensional reconstructions in all three planes. The simultaneous presence of the "anteater nose" sign, the talar beak, or the tapered anterior calcaneal process provides additional diagnostic evidence. In the diagnostic approach of calcaneonavicular coalition, oblique foot radiography seems useful in initially detecting abnormal coalition (bony or not), and complementarily, CT emerges as the best modality to characterize TLAP syndrome.

Validation of the Clenched Fist View in Detecting Scapholunate Ligamentous Injury.

The purpose of this study was to determine the predictive value of the clenched fist stress views in identifying scapholunate ligament injuries. An institutional review board-approved retrospective chart review was conducted of adult patients who underwent diagnostic arthroscopy with a ligamentous wrist injury from 2015 to 2020. Standard posteroanterior, lateral, and clenched fist stress radiographs were reviewed and scapholunate ligament gaps recorded. A total of 124 patients were included, of which 88 had normal standard radiographs and clenched fist radiographs. The positive predictive value of the clenched fist view was 69%, whereas the negative predictive value was 58%. The sensitivity of the clenched fist view was 40%, while the specificity was 82%. Of those patients with a negative clenched fist view, 42% were found to have an arthroscopic Geissler classification of 3 or higher scapholunate ligament injury. Despite the emphasis on stress radiographic views, a normal stress clenched fist view does not preclude arthroscopic findings of a Geissler class 3 or greater injury in symptomatic patients. The sensitivity of a clenched fist view is only 40%. These findings question the utility of stress radiographs when assessing for scapholunate ligament injuries.

Zone 2 Fifth Metatarsal Fractures Treated Nonoperatively Have Similar Time to Healing to Those Treated Operatively.

To quantify the rate of union and time to clinical and radiographic healing in Zone 2 proximal fifth metatarsal (MT) fractures and compare these outcomes between Zone 2 fractures treated operatively and nonoperatively. Retrospective cohort study. Academic Level I Trauma Center. Patients with fifth MT fractures who presented between December 2012 and April 2022 and confirmed to have Zone 2 fractures (defined as fractures entering the proximal 4-5 MT articulation on the oblique radiographic view) were included in the study analysis in either the operative or nonoperative cohort. Nonunion, time to clinical healing by, and time to radiographic healing between operative and nonoperative treatment. Among the 499 included patients, 475 patients (95.2%) were initially treated nonoperatively and 24 patients (4.8%) were treated operatively. Both groups were similar in demographics. There was no difference in the proportion of patients with nonunions between groups (6.1% in the nonoperative group vs. 3.8% in the operative group, P = 1.000). In addition, there was no statistically significant difference between groups with respect to the time to clinical healing (9.9 ± 8.3 weeks for the nonoperative group vs. 15.4 ± 15.0 weeks for the operative group, P = 0.117) or the time to radiographic healing (18.7 ± 12 weeks for the nonoperative group vs. 18.5 ± 16.6 weeks for the operative group, P = 0.970). Zone 2 fifth MT base fractures were successfully treated with nonoperative management. There was no evidence in this study that operative treatment leads to significantly faster clinical or radiographic healing. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Case Report of Polycystic Kidney Disease in a Persian Cat in IPB University Veterinary Teaching Hospital

A 7-year-old male Persian cat was referred to IPB University Veterinary Teaching Hospital with clinical signs of lethargy, weight loss, and loss of appetite and was diagnosed with nephrolithiasis before being referred to IPB University Veterinary Teaching Hospital. Physical examination revealed tachycardia, tachypnoea, pale mucous membrane, 5–6% dehydration rate, cachexia, and palpated masses on the left and right side of the abdominal region. The abdominal cavity was seen as more radiopaque, which resulted in some organs being invisible in the radiographic view. Abdominal ultrasonography showed abnormalities in the liver, gall bladder, and kidneys. The patient was diagnosed with polycystic kidney disease (PKD) with the prognosis of infausta, as the patient was already in a sternal recumbency and could not stand by himself. During hospitalization, the patient was force-fed with a commercial renal diet, and the medical treatments given were intravenous ceftriaxone, vitamins, furosemide, Azodyl®, and intravenous infusion. The patient regained standing ability and survived until the seventh day of hospitalization. However, the owner persisted in bringing the patient home on the seventh day of hospitalization, and the patient died the next day after being brought home.

Use of Craniodorsal–Caudoventral 45° Oblique Radiographs for Diagnosis and Treatment of Coxofemoral Luxation in Two Mohave Desert Tortoises, Gopherus agassizii

Abstract Two injured wild Mohave desert tortoises (Gopherus agassizii) presented with hind leg lameness. A contaminated and infected bite wound exposed the coxofemoral joint in one individual. Dorsoventral, lateral, and craniocaudal radiographs produced less detail of the affected coxofemoral joint in each tortoise due to superimposition of soft tissue, the bones of the shell, pelvis and femur. Radio tracking devices that had been epoxied to the shell also complicated diagnosis with traditional radiographic views. Based on a view described in birds, a craniodorsal-caudoventral 45° oblique image offered a superior view of the coxofemoral joint. This image was used to prescribe a femoral head ostectomy and verify successful completion following surgery.

Evaluation of the results of acute acromioclavicular joint reconstruction using Double Endobutton technique

Abstract Background Acromioclavicular joint (ACJ) dislocation is a common injury, which accounts for ~9% of all shoulder injuries. Surgical techniques for reconstructing or repairing ACJ dislocation have evolved over the last decades. Recent surgical techniques focus on reconstruction of the coracoclavicular ligament to recover the stability of ACJ. Patients and methods This was a prospective case series study that included 23 patients with acute ACJ dislocation, admitted to the Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Kafr El Sheikh and Benha University. All cases were treated by coracoclavicular repair using Double Endobutton technique and Ethibond suture. The follow-up period ranged from 18 to 24 months postoperatively. Outcomes were assessed using Constant score and DASH score at of 6 weeks, 3, 6, 12 months, and final follow up. Radiological assessment was done using Zanca view and stress anteroposterior radiographs of both shoulders to compare acromiohumeral interval at the end of follow up. Results This study included 23 patients that were admitted to our department. Their mean age were 34.2 ± 2.3 years. The average time between injury and surgery was 5.2 ± 1.4 days. There were 20 men and three females. Regarding DASH score it improved from preoperative value of 88.3 ± 11.2 points to 14.3 ± 2.4 points. Regarding Constant score, it improved significantly from preoperative value of 45.3 ± 2.2 points to a postoperative value of 92.3 ± 3.6 points. Regarding acromiohumeral interval, the mean distance was 9.3 mm immediate postoperative period, and it was 10.1 at the end of follow up (P>0.05). Conclusion ACJ reconstruction using Double Endobutton technique is safe, easy, and effective technique in cases with acute ACJ dislocation with little postoperative complications and excellent clinical and radiological outcomes.

Radiographic assessment of normal parameters of forelimb distal phalanx in Turkmen horses.

The Turkmen horse is one of the oldest breeds in the world with unique characteristics in agility, endurance and jump, being publicly acclaimed. Laminitis affects the limbs and decreases athletic performance. Radiographic evaluation is essential to confirm the sinking diagnosis in every breed of a horse suffering from laminitis. Since no information about distal phalanx radiographic measurements in this breed has been reported, the current study was designed and conducted. In the present study, 24 clinically sound registered Turkmen horses of both sexes (15 mares and nine stallions) were selected. Lateromedial radiographic views of both front distal phalanges were taken, focusing on the distal phalanx. After magnification correction, images were used to measure founder distances (FD) and other distal phalanx radiographic measurements using an image processing program. There was no significant difference between radiographic measurements of the left and right front feet. The FD had a significant positive correlation with weight. The horses under 3 years of age had a significantly greater U angle than the horses over the age of three. Also, palmarocortical length (PCL) in the Turkmen stallions was significantly higher than mares. In this investigation, PCL in horses under the age of three was significantly lower than horses over 3 years of age. The values determined in this study can be used as baseline data of front feet in Turkmen horses.

Radiographic and sonographic features, and histogram parameters of the liver and spleen in healthy Toco toucans (Ramphastos toco, Müller 1976).

This study aimed to evaluate radiographic and sonographic features, and histogram parameters based on grayscale ultrasound of the liver and spleen in healthy toco toucans. Fifteen adult toco toucans (Ramphastos toco), seven females and eight males, weighing approximately 650 g, were enrolled in the study. On the right lateral radiographic view, the liver was visualized in the midventral region of the coelomic cavity; ultrasonographically, the liver was located in the middle portion of the coelomic cavity in close relationship to the heart, and thoracic and abdominal air sacs. Two hepatic lobes were identified; the right lobe was larger than the left one. The spleen was visualized in 10 toco toucans on radiographs and only in eight toucans on ultrasound exams. The gallbladder was identified only on ultrasound. On the right lateral radiographic view, the spleen was visualized dorsal to the proventriculus and ventral to the lungs/air sacs as an oval shape. Ultrasonographically, the spleen was observed caudal to the liver, cranial to the proventriculus and craniodorsal to the ventriculus. There was no significant difference in spleen length for either radiographic or ultrasound measurements. The brightness intensity (BI) for mean graylevel (G) and standard deviation of gray levels (SG ) in the liver were 101.315 (± 16.170) and 12.453 (± 2.616), respectively. Mean G and SG levels in the spleen were 63.940 (± 18.321) and 7.494 (± 3.595), respectively. In conclusion, the sonographic features and histogram parameters indicated that the liver is more echogenic and heterogeneous than the spleen, which must be considered for diagnosing alterations in these organs.

Rare Indication of Atlantoaxial Fusion-failed Conservative Management of Primary Atlantoaxial Osteoarthritis

Introduction: Osteoarthritis of the atlantoaxial joint is a significant cause of occipitocervical pain, which is often missed and has an increasing prevalence with age. The patients typically present with occipitocervical pain and restricted and painful neck rotations. Despite the primary reliance on conservative management for this pathology, surgical intervention becomes crucial for those not responding to standard conservative treatment. The presented case series highlights the rarity of the requirement of surgical intervention in the management of Atlantoaxial osteoarthritis (AAOA) and the clinical outcomes of surgical management in AAOA. Case Report: This paper presents a case series of four patients who were managed surgically with atlantoaxial fusion, from a database of 108 patients with AAOA. The case series includes three males and one female with a mean age of presentation being 67.5 years. All four patients presented with occipitocervical pain, and painful neck movements and were diagnosed with AAOA on the anteroposterior open mouth view radiographs showing changes of osteoarthritis such as bone erosions, sclerosis, osteophytes. The patients were managed conservatively with non-steroidal anti-inflammatory drugs, intra-articular steroid injections, and cervical collar immobilization. Those not responding to conservative management and with incapacitating pain were managed surgically with atlantoaxial fusion procedures. Conclusion: In a group of patients with a painful and debilitating degenerative AAOA only a small proportion of cases require surgical intervention. In this cohort, only 3.70 % of patients required surgery, highlighting the rarity of surgical intervention required in the management of AAOA. Nevertheless, when conducted, atlantoaxial fusion has proved to be efficacious with a low rate of serious complications and the patient self-rated outcome in terms of post-operative visual analog scale score and neck disability index scores indicating a high degree of satisfaction with the procedures. Keywords: Atlantoaxial, osteoarthritis, fusion, transarticular screws.

Evaluation of thoracic inlet view plain radiograph in the management of patients with goitre.

Thoracic inlet view radiograph is an investigation for assessing patients with goitre in many centres in the sub-Saharan-region. However, there is paucity of information on its usefulness in the diagnosis of retrosternal goitre (RSG) and in planning for thyroidectomy. A review of patients with goitre managed in the Division of Endocrine Surgery, University College Hospital, Ibadan, Nigeria, between 2002 and 2014 was done. Data were obtained from Operating Theatre Log and electronic data archive of the Division. Clinical RSG (CRSG) was taken as a gland that the examining fingers could not get below its lower margin and Radiological RSG (RRSG) on thoracic inlet view was any extension of the thyroid gland beyond the thoracic inlet. Intra-operatively, if any part of the gland extends beyond the thoracic inlet it was considered as an RSG. 221 (96.5%) of the 229 patients who had thoracic inlet plain radiograph were included in this study. The Male to Female ratio was 1:5.5. WHO grade III goitre was seen in 56.1% of the patients and 43.9% had grade II goitre. The CRSG, RRSG and Intra-operative RSG were seen in 7.7%, 16.7% and 17.6% respectively. The specificity and sensitivity of clinical examination in determining RSG was 88.7% and 94.1% and that of Thoracic inlet radiograph was 97.8% and 94.6% respectively. It is a useful study for screening patients with goitre for retrosternal extension, however it could not be used to determine the need for extra-cervical surgical access during thyroidectomy.

Computed tomography-based patient-specific cutting guides used for positioning of the femoral component of implants during unicompartmental knee arthroplasty: a cadaver study

BackgroundTo investigate whether patient-specific instrumentation (PSI) improves the femoral component positioning of implants during unicompartmental knee arthroplasty (UKA) using cadaver bone models.MethodsFifty adult cadaveric femoral bone specimens collected from February 2016–2018, were randomized to receive medial UKA with a PSI guide (n = 25) or conventional instrumentation (CI) (n = 25). Standard anteroposterior and lateral view radiographs were obtained postoperatively to assess the coronal and sagittal positioning of the femoral prostheses, respectively. The osteotomy time was recorded to assess the convenience of PSI in guiding osteotomy.ResultsOsteotomy time significantly shortened in the PSI group (3.12 ± 0.65 versus 4.33 ± 0.73 min, p < 0.001). There was a significant difference in the postoperative coronal alignment of the femoral component between the PSI and CI groups (varus/valgus angle: 1.43 ± 0.93° vs. 2.65 ± 1.50°, p = 0.001). The prevalence of outliers in coronal alignment was lower in the PSI than the CI group (2/25, 8% vs. 9/25, 36%). Sagittal posterior slope angle of the femoral component was significantly different between the two groups (8.80 ± 0.65° and 6.29 ± 1.88° in the CI and PSI groups, respectively, p < 0.001). The malalignment rate of the femoral component in the sagittal plane was 60% in the CI group, whereas no positioning deviation was observed in the PSI group.ConclusionThis study used a cadaver model to support the fact that CT-based PSI shows an advantage over CI in optimizing implant positioning for UKAs.

Association of Bone Shape and Alignment Analyzed Using Statistical Shape Modeling With Severity of First Metatarsophalangeal Joint Osteoarthritis.

We aimed to explore the relationship between bone shape and radiographic severity in individuals with first metatarsophalangeal joint osteoarthritis (first MTP joint OA). Weightbearing lateral and dorsoplantar radiographs were obtained for the symptomatic foot of 185 participants (105 females, aged 22 to 85 years) with clinically diagnosed first MTP joint OA. Participants were classified into none/mild, moderate, or severe categories using a standardized atlas. An 80-point model for lateral radiographs and 77-point model for dorsoplantar radiographs was used to define independent modes of variation using statistical shape modeling software. Odds ratios adjusted for confounders were calculated using ordinal regression to determine the association between radiographic severity and mode scores. After assessment and grading of radiographs, 35 participants (18.9%) were included in the none/mild first MTP joint OA severity category, 69 (37.2%) in the moderate severity category, and 81 (43.7%) in the severe category. For lateral-view radiographs, 16 modes of variation were included, which collectively represented 83.2% of total shape variance. Of these, four modes were associated with radiographic severity. For dorsoplantar-view radiographs, 15 modes of variation were included, representing 82.6% of total shape variance. Of these, six modes were associated with radiographic severity. Variations in the shape and alignment of the medial cuneiform, first metatarsal, and proximal and distal phalanx of the hallux are significantly associated with radiographic severity of first MTP joint OA. Prospective studies are required to determine whether bone shape characteristics are associated with the development and/or progression of this condition.

Postoperative Measurement of the Retropharyngeal Space Predicts the Risk of Dysphagia After Anterior Cervical Diskectomy and Fusion.

Postoperative dysphagia is a common complication of anterior cervical diskectomy and fusion (ACDF), although its pathophysiology remains poorly understood. Patients with severe dysphagia may suffer from serious complications such as aspiration pneumonia, in addition to difficulty with oral intake or malnutrition; therefore, a prompt indicator for postoperative management would be helpful. We quantitatively evaluated the retropharyngeal space (RS) after ACDF and investigated its association with postoperative dysphagia. This multicenter retrospective study analyzed the clinical data of 82 consecutive patients who underwent ACDF. The anteroposterior distance (APD) of the RS was measured at the C2 level using a lateral radiographic view on postoperative day 1. Postoperative dysphagia was subjectively assessed using the Bazaz-Yoo Dysphagia Severity Scale. We statistically evaluated the association between the APD of the RS and postoperative dysphagia. The mean APD of the RS in all 82 patients was 3.6 mm preoperatively and significantly increased to 8.2 mm postoperatively (P < .0001). Twenty-two patients (26.8%) had postoperative dysphagia. Multivariable analysis revealed that the postoperative APD was associated with postoperative dysphagia (odds ratio 1.27, 95% CI 1.10-1.50, P = .0007). The receiver operating characteristic curve (area under the curve 0.70, 95% CI 0.58-0.83) demonstrated that the postoperative APD of the RS cutoff value was 6.1 mm, with a sensitivity of 100% and a specificity of 35%. With this cutoff value, the positive and negative predictive values for postoperative dysphagia were 36% and 100%, respectively. Our data demonstrate that a value of 6.1 mm for the APD of the RS is an effective indicator for dysphagia after ACDF, which contributes to optimizing the patient management in the acute postoperative period.

When to Do Selective Patellar Resurfacing in Total Knee Arthroplasty: A Decision-Making Algorithm Based on Pre-operative and Intra-operative Findings.

Persistent anterior knee pain post total knee arthroplasty (TKA) is a significant cause of patient dissatisfaction. Selective patellar resurfacing is commonly practiced for primary total knee replacement (TKR) but there is a paucity in literature regarding its decision making. This study aims to develop a decision-making algorithm for selective patellar resurfacing using Hospital for Special Surgery Patello-femoral Assessment score (HSS PFA score), weight-bearing patellofemoral X-ray, and intraoperative cartilage wear assessment based on the Outerbridge classification. This prospective study enrolled 65 patients, assessing preoperative factors including HSS PFA score and Baldini view radiography. Intraoperative cartilage wear was categorized using the Outerbridge classification. Preoperative findings were correlated with intraoperative outcomes through statistical analysis, leading to the development of a predictive algorithm. The efficiency of algorithm was assessed at 3-year follow-up using HSS PFA score. A significant negative correlation (r = -0.272, p = 0.029) was observed between HSS PFA score and cartilage wear. However, no significant relationships were established between HSS PFA score and Baldini view observations, including radiological tilt (p = 0.517) and displacement (p = 0.277). Intraoperative cartilage wear versus patellar tilt (p = 0.65) and displacement (p = 0.837) also yielded non-significant results. Three-year follow-up examinations revealed no complications and significant HSS PFA score improvements in all patients. The requirement for patellar resurfacing can be predicted using a combination of preoperative parameter such as HSS PFA score and the intra-operative cartilage wear. We put forward an algorithm based on above findings to aid in the decision making.

Application of Artificial Intelligence in Clinical Dentistry, a Comprehensive Review of Literature.

In recent years, the use of artificial intelligence (AI) has become increasingly popular in dentistry because it facilitates the process of diagnosis and clinical decision-making. However, AI holds multiple prominent drawbacks, which restrict its wide application today. It is necessary for dentists to be aware of AI's pros and cons before its implementation. Therefore, the present study was conducted to comprehensively review various applications of AI in all dental branches along with its advantages and disadvantages. For this review article, a complete query was carried out on PubMed and Google Scholar databases and the studies published during 2010-2022 were collected using the keywords "Artificial Intelligence", "Dentistry," "Machine learning," "Deep learning," and "Diagnostic System." Ultimately, 116 relevant articles focused on artificial intelligence in dentistry were selected and evaluated. In new research AI applications in detecting dental abnormalities and oral malignancies based on radiographic view and histopathological features, designing dental implants and crowns, determining tooth preparation finishing line, analyzing growth patterns, estimating biological age, predicting the viability of dental pulp stem cells, analyzing the gene expression of periapical lesions, forensic dentistry, and predicting the success rate of treatments, have been mentioned. Despite AI's benefits in clinical dentistry, three controversial challenges including ease of use, financial return on investment, and evidence of performance exist and need to be managed. As evidenced by the obtained results, the most crucial progression of AI is in oral malignancies' diagnostic systems. However, AI's newest advancements in various branches of dentistry require further scientific work before being applied to clinical practice. Moreover, the immense use of AI in clinical dentistry is only achievable when its challenges are appropriately managed.

The "Standing Peanut" Scaphoid View: A Semi-supinated Radiographic View for Intraoperative Evaluation of Screw Placement in Scaphoid Waist Fractures.

Scaphoid waist fractures are the most common fracture of the scaphoid. Operative management is indicated with unstable fractures and often for nondisplaced waist fractures to decrease time to union and return to work/sport. Screw placement within the central axis of the scaphoid is paramount and correlates with outcomes. Assessment of intrascaphoid screw placement is classically done via intraoperative fluoroscopy. An additional fluoroscopic view is presented to assist in confirming implant positioning. Along with the standard anterioposterior, lateral, pronated oblique, and "scaphoid" view we obtain a "standing peanut" view for assessment of central screw placement. This view also allows for further evaluation of center/center positioning and better assessment of fixation crossing the fracture into the proximal pole. The "standing peanut" view is best obtained in a sequential manner beginning with the forearm in neutral rotation. First, the forearm is then supinated 30 degrees; next, the wrist is placed at 45 degrees of ulnar deviation. Then finally, 10 degrees of wrist extension. We utilize this additional intraoperative view in conjunction with the standard fluoroscopic views for assessing and ensuring center-center implant positioning, particularly within the proximal pole. When ensuring center-center positioning, we prefer this view as an adjunct view to the standard fluoroscopic views intraoperatively. It provides a beneficial view of the proximal pole delineating the number of screw threads that have obtained proximal pole purchase. We have found it particularly useful in the setting of scaphoid waist fracture nonunion with the classic 'humpback' deformity after correction with volar interposition grafting. Standard radiographic views may be misinterpreted regarding implant positioning if there remains any residual flexion. The view requires little in the way of training to obtain once appreciated and exposes the patient to minimal additional radiation.

Constructing a clinical radiographic knee osteoarthritis database using artificial intelligence tools with limited human labor: A proof of principle

ObjectiveTo create a scalable and feasible retrospective consecutive knee osteoarthritis (OA) radiographic database with limited human labor using commercial and custom-built artificial intelligence (AI) tools. MethodsWe applied four AI tools, two commercially available and two custom-built tools, to analyze six years of clinical consecutive knee radiographs from patients aged 35 to 79 at the University of Copenhagen Hospital, Bispebjerg-Frederiksberg Hospital, Denmark. The tools provided Kellgren-Lawrence (KL) grades, joint space widths, patella osteophyte detection, radiographic view detection, knee joint implant detection, and radiographic marker detection. ResultsIn total, 25,778 knee radiographs from 8,575 patients were included in the database after excluding inapplicable radiographs, and 92.5 % of the knees had a complete OA dataset. Using the four AI tools, we saved about 800 hours of radiologist reading time and only manually reviewed 16.0 % of the images in the database. ConclusionsThis study shows that clinical knee OA databases can be built using AI with limited human reading time for uniform grading and measurements. The concept is scalable temporally and across geographic regions and could help diversify further OA research by efficiently including radiographic knee OA data from different populations globally. We can prevent data dredging and overfitting OA theories on existing trite cohorts by including various gene pools and continuous expansion of new clinical cohorts. Furthermore, the suggested tools and applied approaches provide an ability to retest previous hypotheses and test new hypotheses on real-life clinical data with current disease prevalence and trends.

Osteochondrodysplasia and the c.1024G>T variant of TRPV4 gene in Scottish Fold cats: genetic and radiographic evaluation.

The objectives of this study were to investigate the c.1024G>T SNP in the TRPV4 gene in Scottish Straight and Fold cats, and to evaluate the pattern of skeletal phenotype and the evolution of radiological signs of Scottish Fold osteochondrodysplasia (SFOCD) over time in heterozygous subjects. DNA was obtained from blood samples of 17 cats (Scottish Fold: n = 12; Scottish Straight: n = 5) and subsequently genotyped by sequencing in a 249 bp region of the TRPV4 gene (exon 6), including the known c.1024G>T causative mutation for osteochondrodysplasia. Orthopaedic and radiographic analyses were performed on animals carrying the mutant allele. Genotyping by sequencing confirmed that all and only the Scottish Fold cats carried the mutant allele in a heterozygous asset. Furthermore, two other exon variants, already described in the literature as silent variants, were found in some of the sampled cats. Comparative orthogonal radiographic views of the shoulder, elbow, carpus, hip, stifle and tarsus were obtained. A mediolateral projection of the thoracic and lumbar column was also performed. Three out of four cats were clinically and radiographically examined again 1.5 years later. Although the presence of the mutant allele in all the tested Scottish Fold cats was confirmed, only 1/12 showed clinical signs of SFOCD. Furthermore, no cats in the 1.5-year follow-up showed skeletal changes. Although significant, the c.1024G>T mutation in the TRPV4 gene, supposedly, is not the only cause or risk of developing SFOCD.

Evaluation of the Outcome of Transpedicular Fixation for Thoracic and Lumbar Tuberculous Spine Disease

Objective: Pakistan stands sixth in countries, contributing 60% of new TB cases worldwide. TB can involve a wide variety of organs including the spine which at times need neurosurgical intervention. This study aims to determine the overall clinical and radiological outcomes in patients with dorsolumbar spine TB managed by posterior transpedicular screw fixation. The study focused to evaluate the outcome of transpedicular screws fixation for the thoracic and lumbar tuberculous spine. Materials and Methods: The study included a total of 60 patients were observed. A complete history and systemic physical examination was done. Pre-operative anteroposterior and lateral view radiographs were taken to measure the height of the vertebral body, kyphotic angulation, and sagittal plane index. Short-segment transpedicular fixation was done under general anesthesia by consultant neurosurgeons. All patients were asked for follow-up after one month. Post-operative anteroposterior plus lateral view radiographs were done to measure the height of the vertebral body, kyphotic angulation, and sagittal index. Results: In our study mean age was 47 years. 58%patients were males and 42% of patients were female. The mean postoperative vertebral height was 18.93 mm ± 1.17 and the mean postoperative Kyphotic angle was 9.68 degree ± 4.03º. The mean postoperative Sagittal index was 5.83 ± 4.55. Conclusion: The outcome of transpedicular fixation of vertebral height was 18.93 mm ± 1.17, Kyphotic angle was 9.68 degree ± 4.03º) and Sagittal index was (5.83 ± 4.55) for thoracic &amp; lumbar tuberculous spine.

Assessing the Potential of a Deep Learning Tool to Improve Fracture Detection by Radiologists and Emergency Physicians on Extremity Radiographs

To evaluate the standalone performance of a deep learning (DL) based fracture detection tool on extremity radiographs and assess the performance of radiologists and emergency physicians in identifying fractures of the extremities with and without the DL aid. The DL tool was previously developed using 132,000 appendicular skeletal radiographs divided into 87% training, 11% validation, and 2% test sets. Stand-alone performance was evaluated on 2626 de-identified radiographs from a single institution in Ohio, including at least 140 exams per body region. Consensus from three US board-certified musculoskeletal (MSK)radiologists served as ground truth. A multi-reader retrospective study was performed in which 24 readers (eight each of emergency physicians, non-MSK radiologists, and MSK radiologists) identified fractures in 186 cases during two independent sessions with and without DLaid, separated by a one-month washout period. The accuracy (area under the receiver operating curve), sensitivity, specificity, and reading time werecompared withand without model aid. The model achieved a stand-alone accuracy of 0.986, sensitivity of 0.987, and specificity of 0.885, and high accuracy (> 0.95) across stratification for body part, age, gender, radiographic views, and scanner type. With DL aid, reader accuracy increased by 0.047 (95% CI: 0.034, 0.061; p=0.004) and sensitivity significantly improved from 0.865 (95% CI: 0.848, 0.881) to 0.955 (95% CI: 0.944, 0.964). Average reading time was shortened by 7.1s (27%) per exam. When stratified by physician type, this improvement was greater for emergency physicians and non-MSK radiologists. The DL tool demonstrated high stand-alone accuracy, aided physician diagnostic accuracy, and decreased interpretation time.