Routine Radiographs Research Articles

Is a chest radiograph indicated after chest tube removal in trauma patients? A systematic review.

The aim of this systematic review was to assess the necessity of routine chest radiographs after chest tube removal in ventilated and nonventilated trauma patients. A systematic literature search was conducted in MEDLINE, Embase, CENTRAL, and CINAHL on May 15, 2020. Quality assessment was performed using the Methodological Index for Nonrandomized Studies criteria. Primary outcome measures were abnormalities on postremoval chest radiograph (e.g., recurrence of a pneumothorax, hemothorax, pleural effusion) and reintervention after chest tube removal. Secondary outcome measures were emergence of new clinical symptoms or vital signs after chest tube removal. Fourteen studies were included, consisting of seven studies on nonventilated patients and seven studies on combined cohorts of ventilated and nonventilated patients, all together containing 1,855 patients. Nonventilated patients had abnormalities on postremoval chest radiograph in 10% (range across studies, 0-38%) of all chest tubes and 24% (range, 0-78%) of those underwent reintervention. In the studies that reported on clinical symptoms after chest tube removal, all patients who underwent reintervention also had symptoms of recurrent pathology. Combined cohorts of ventilated and nonventilated patients had abnormalities on postremoval chest radiograph in 20% (range, 6-49%) of all chest tubes and 45% (range, 8-63%) of those underwent reintervention. In nonventilated patients, one in ten developed recurrent pathology after chest tube removal and almost a quarter of them underwent reintervention. In two studies that reported on clinical symptoms, all reinterventions were performed in patients with symptoms of recurrent pathology. In these two studies, omission of routine postremoval chest radiograph seemed safe. However, current literature remains insufficient to draw definitive conclusions on this matter, and future studies are needed. Systematic review study, level IV.

A Novel Shorthand Approach to Knee Bone Age Using MRI: A Validation and Reliability Study.

Background:Bone-age determination remains a difficult process. An atlas for bone age has been created from knee-ossification patterns on magnetic resonance imaging (MRI), thereby avoiding the need for radiographs and associated costs, radiation exposure, and clinical inefficiency. Shorthand methods for bone age can be less time-consuming and require less extensive training as compared with conventional methods.Purpose:To create and validate a novel shorthand algorithm for bone age based on knee MRIs that could correlate with conventional hand bone age and demonstrate reliability across medical trainees.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Included in this study were adolescent patients who underwent both knee MRI and hand bone age radiographs within 90 days between 2009 and 2018. A stepwise algorithm for predicting bone age using knee MRI was developed separately for male and female patients, and 7 raters at varying levels of training used the algorithm to determine the bone age for each MRI. The shorthand algorithm was validated using Spearman rho (rS) to correlate each rater’s predicted MRI bone age with the recorded Greulich and Pyle (G&P) hand bone age. Interrater and intrarater reliability were also calculated using intraclass correlation coefficients (ICCs).Results:A total of 38 patients (44.7% female) underwent imaging at a mean age of 12.8 years (range, 9.3-15.7 years). Shorthand knee MRI bone age scores were strongly correlated with G&P hand bone age (rS = 0.83; P < .001). The shorthand algorithm was a valid predictor of G&P hand bone age regardless of level of training, as medical students (rS = 0.75), residents (rS = 0.81), and attending physicians (rS = 0.84) performed similarly. The interrater reliability of our shorthand algorithm was 0.81 (95% CI, 0.73-0.88), indicating good to excellent interobserver agreement. Respondents also demonstrated consistency, with 6 of 7 raters demonstrating excellent intrarater reliability (median ICC, 0.86 [range, 0.68-0.96]).Conclusion:This shorthand algorithm is a consistent, reliable, and valid way to determine skeletal maturity using knee MRI in patients aged 9 to 16 years and can be utilized across different levels of orthopaedic and radiographic expertise. This method is readily applicable in a clinical setting and may reduce the need for routine hand bone age radiographs.

KNEE RADIOGRAPHS DEMONSTRATE SMALL BUT STATISTICALLY SIGNIFICANT INCREASE IN POSTERIOR TIBIAL SLOPE IN PATIENTS WITH OSGOOD-SCHLATTER DISEASE

Background:Previous research has demonstrated an association between Osgood-Schlatter disease (OSD) and increased posterior tibial slope (PTS) in a small subset of patients with MRI and clinical exam consistent with OSD.Hypothesis/Purpose:To determine if children diagnosed clinically with OSD have an increased PTS on routine radiographs compared to controls.Methods:Patients 10-18 years old with the clinical diagnosis of OSD and a true lateral knee X-ray between 2016 and 2019 were eligible for the OSD group. Subjects were excluded if they had other significant knee pathology (Figure 1). The same number of controls were selected from patients in the same age and date range with history of anterior knee pain and a true lateral knee X-ray but no evidence of OSD or other significant pathology on clinical exam or X-ray. Demographic data and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores were collected for each subject. PTS measurements were performed on true lateral X-Rays by three blinded investigators. Independent samples t-test and chi-squared test were used to compare variable means and frequency between OSD and control knees. Logistic regression analysis was used to investigate the effects of OSD, age, sex, height, weight, and HSS Pedi-FABS score on PTS (≥12º versus <12º).Results:258 total knees (129 with OSD and 129 controls) were included. Mean age was 12.9 ± 1.8 years and 53% knees were male. There were no differences in age, sex, BMI, or laterality of knees between groups (Table 1). Mean PTS was significantly higher in the OSD group (11.6º ± 2.9º) compared to the control group (9.3º ± 2.7º, p<0.0001). In the OSD group, 46% of knees had a PTS ≥12º and in the control group, 19% knees had a PTS >12º (p<0.001). Logistic regression analysis showed that patients with OSD had 3.63 greater odds (95% CI 1.78-7.40) of having PTS ≥12º compared to patients without OSD, when controlling for age, sex, height, weight, and HSS Pedi-FABS score (Table 2).Conclusion:This study further supports an association between OSD and a mild increase in PTS. Patients with OSD had 3.6 greater odds of having PTS≥12º. The clinical implications of this finding have not yet been elucidated. We speculate that in patients with OSD, stresses (or force) exerted from the quadriceps muscle group through the patellar tendon loads the anterior portion of the tibia tubercle disproportionately to the posterior segment and causes asymmetric growth and an increased PTS.Tables/ FiguresFigure 1.Flowchart depicting OSD group patient exclusion.

Limited Clinical Utility of Chest Radiography in Asymptomatic Patients after Interventional Radiology-Performed Ultrasound-Guided Thoracentesis: Analysis of 3,022 Consecutive Patients

Abstract Purpose The aim of this study was to report the utility of chest radiography following interventional radiology-performed ultrasound-guided thoracentesis. Materials and Methods A total of 3,998 patients underwent thoracentesis between 2003 and 2018 at two institutions. A total of 3,022 (75.6%) patients were older than 18 years old, underwent interventional radiology-performed ultrasound-guided thoracentesis, and had same-day post-procedure chest radiograph evaluation. Patient age (years), laterality of thoracentesis, procedural technical success, volume of fluid removed (mL), method of post-procedure chest imaging, absence or presence of pneumothorax, pneumothorax size (mm), pneumothorax management measures, and clinical outcomes were recorded. Technical success was defined as successful aspiration of pleural fluid. Post-procedure clinical outcomes included new patient-perceived dyspnea and hypoxia (oxygen saturations &lt; 90% on room air). Costs associated with radiographs were estimated using Medicare and Medicaid fee schedules. Results Mean age was 56.7 ± 15.5 years. Interventional radiology-performed ultrasound-guided thoracentesis was performed on the left (n = 1,531; 50.7%), right (n = 1,477; 48.9%), and bilaterally (n = 14; 0.5%) using 5-French catheters. Technical success was 100% (n = 3,022). Mean volume of 940 ± 550 mL of fluid was removed. Post-procedure imaging was performed in the form of posteroanterior (PA) (2.6%; 78/3,022), anteroposterior (AP) (17.0%; 513/3,022), PA and lateral (77.9%; 2,355/3,022), or PA, lateral, and left lateral decubitus (2.5%; 76/3,022) chest radiographs. Post-procedural pneumothorax was identified in 21 (0.69%) patients. Mean pneumothorax size, measured on chest radiograph as the longest distance from the chest wall to the lung, was 18.8 ± 10.2 mm (range: 5.0–35.0 mm). Of the 21 pneumothoraces, 7 (33.3%) were asymptomatic, resolved spontaneously, and had a mean size of 6.4 ± 2.4 mm. Fourteen pneumothoraces, of mean size 25.0 ± 5.8 mm, required management with a pleural drainage catheter (66.6%). The overall incidence of pneumothorax requiring pleural drainage catheter placement following interventional radiology-performed ultrasound-guided thoracentesis was 0.46% (14/3,022). Of the patients requiring drainage catheter placement, 12/14 (85.7%) and 13/14 (92.9%) had dyspnea and hypoxia, respectively. Potential costs to Medicare and Medicaid, for chest radiographs, in this study, were $27,547 and $10,581, respectively. Conclusion The incidence of clinically significant pneumothorax requiring catheter drainage following interventional radiology-operated ultrasound-guided thoracentesis is exceedingly low (0.46%), and routine post-procedure chest radiographs in asymptomatic patients provide little value. Reserving post-procedure chest radiographs for patients with post-procedure dyspnea or hypoxia will result in more efficient resource utilization and health care cost savings.

Does routine postoperative contrast radiography improve outcomes for patients with perforated peptic ulcer? A multicenter retrospective cohort study

BackgroundPerforated peptic ulcer is a morbid emergency general surgery condition. Best practices for postoperative care remain undefined. Surgical dogma preaches practices such as peritoneal drain placement, prolonged nil per os, and routine postoperative enteral contrast imaging despite a lack of evidence. We aimed to evaluate the role of postoperative enteral contrast imaging in postoperative perforated peptic ulcer care. Our primary objective was to assess effects of routine postoperative enteral contrast imaging on early detection of clinically significant leaks. MethodsWe conducted a multicenter retrospective cohort study of patients who underwent repair of perforated peptic ulcer between July 2016 and June 2018. We compared outcomes between those who underwent routine postoperative enteral contrast imaging and those who did not. ResultsOur analysis included 95 patients who underwent primary/omental patch repair. The mean age was 60 years, and 54% were male. Thirteen (14%) had a leak. Eighty percent of patients had a drain placed. Nine patients had leaks diagnosed based on bilious drain output without routine postoperative enteral contrast imaging. Use of routine postoperative enteral contrast imaging varied significantly between institutions (30%–87%). Two late leaks after initial normal postoperative enteral contrast imaging were confirmed by imaging after a clinical change triggered the second study. Two patients had contained leaks identified by routine postoperative enteral contrast imaging but remained clinically well. Duration of hospital stay was longer in those who received routine postoperative enteral contrast imaging (12 vs 6 days, median; P = .000). ConclusionRoutine postoperative enteral contrast imaging after perforated peptic ulcer repair likely does not improve the detection of clinically significant leaks and is associated with increased duration of hospital stay.

Prevalence of soft tissue calcifications in panoramic radiographs of the maxillofacial region of older adults.

To investigate the presence of soft tissue calcifications in the head and neck region on panoramic radiographs of older adults. We analysed 1176 panoramic radiographs obtained between January 2013 and December 2018 from individuals of both sexes aged 60years or older, who were referred by dental specialities to the Dental Imaginology Service of the Federal University of Rio Grande do Norte, Brazil. The types of soft tissue calcification evaluated were as follows: carotid artery calcification (CAC), thyroid cartilage calcifications, triticeous cartilage calcifications, sialoliths, tonsilloliths and lymph node calcifications. The presence of soft tissue calcifications was correlated with age and sex. The chi-square test with continuity correction was used for the calculation of p values and the evaluation of the proposed associations. Prevalence ratios and 95% confidence intervals were also calculated. At least one type of soft tissue calcification was found in 43% of the sample. The main calcifications detected were CAC, thyroid and triticeous cartilage calcifications, tonsilloliths,sialoliths, calcified lymph nodes, and phleboliths. Mean patient age was 67.47years and there was a predominance of females (62.8%) in the sample. Bivariate analysis showed a statistically significant association between female sex and the presence of thyroid and triticeous cartilage calcifications and between male sex and the presence of tonsilloliths. Routine panoramic radiography permits the identification of soft tissue calcifications that may be indicators of future cardiovascular disorders, the referral to a medical service and the establishment of therapies for stroke prevention.

Inadvertent, intraoperative, non- to minimally displaced periprosthetic humeral shaft fractures in RTSA do not affect the clinical and radiographic short-term outcome

IntroductionLittle information is available on the clinical and radiographic outcome of intraoperative, non- to minimally displaced humeral fractures that occur during implantation of a stemmed, reverse shoulder prosthesis but are only recognized on routine postoperative radiographs. The goal of this study is to report the clinical and radiographic outcome for this rarely reported fracture type.Materials and methods39 conservatively treated non- to minimally displaced intraoperative periprosthetic humeral fractures after stemmed RTSA were detected from our radiographic database between 1.1.2006 and 31.1.2018. Exclusion criteria were lack of patient consent, preoperative humeral fracture, and revision arthroplasties. Clinical (absolute and relative Constant score, the Subjective Shoulder Value) and radiographic (conventional radiographs) assessment was performed preoperatively, at 6 weeks (only radiographically) and at latest follow-up with a minimum follow-up of 2 years.Results35 patient’s with a mean age of 72 years (range 32–88, SD ± 11 years) and a mean follow-up of 53 months (range 24–124, SD ± 31) were included in the study. At latest follow-up, all clinical outcome parameters except external rotation improved significantly. A complication rate of 17% (n:6) was recorded. At 6 weeks after the index surgery, none of the radiographs showed a fracture displacement or a sintering of the stem. At latest follow-up, all fractures were healed and no stem loosening was observed in any of the shoulders.ConclusionsNon- to minimally displaced intraoperative periprosthetic humeral fractures in RTSA have an incidence of about 5% in this series of mainly uncemented press-fit stems. They generally heal without any further treatment and are not associated with stem loosening or compromise the clinical outcome after primary RTSA. Except slight restriction in the postoperative rehabilitation protocol, no further attention or action is needed.

Pump position and thrombosis in ventricular assist devices: Correlation of radiographs and CT data.

Malpositioning of left ventricular assist devices (LVAD) is a risk factor for thrombosis, but its identification from clinical imaging remains challenging. X-rays and CT scans were analyzed and parameters identified that correlated to pump thrombosis. Retrospective imaging data of patients (n = 115) with HeartmateII (HMII) or HVAD were analyzed in two groups (pump-thrombosis PT, n = 15 vs matched control group NT, n = 15) using routine X-rays and CT scans. In CT, directional deviations of the inflow cannula in three-chamber and two-chamber view (α and β angles) were identified. In HVAD PT frontal radiographs showed reduced pump body area and smaller minor axis (PT 41.3 ± 4.8 mm vs NT 34.9 ± 6.0 mm, p = 0.026), and in the lateral radiographs the visibility of the inflow cannula served as a predictive parameter for PT. In HMII patients, no parameters were associated with PT. The angle α differed significantly (NT −1.2 ± 7.5°, PT −22.0 ± 4.7°, p = 0.006) in HVAD patients. Further, correlations of x-ray parameters with CT angles α and β showed that radiographs can be used to identify malpositioned pumps. Well-aligned inflow cannula positions are essential. HVAD patients with a posterior rotation of the inflow cannula have a higher risk of pump thrombosis. This risk can reliably be identified from routine radiographs.

The elastic stable intramedullary nails as an alternative treatment for adult humeral shaft fractures.

Plate and locked intramedullary nailing for humeral fractures are golden standard procedure, but the humerus is a nonweight-bearing bone and can tolerate a larger range of acceptable alignment. We believe the elastic stable intramedullary nails (ESINs) can provide enough relative stability for humeral shaft fractures in certain adult patients. There are four new indications for using ESINs: (1) patient could not tolerate a sugar-tong splint but was a high risk for general anesthesia, (2) intramedullary canal narrowing (<7 mm), (3) long spiral or oblique fracture over the metadiaphyseal junction, and (4) obesity. All patients received retrograde fixation with two titanium elastic nails, except for one patient with a long spiral fracture over the proximal metadiaphysis. Patients had routine follow-up plain radiographs until bone union, and we evaluated functional results of patients by Mayo Elbow Performance Score and asked to complete Quick Disabilities of the Arm, Shoulder and Hand score at the last outpatient clinic visit. A total of 16 patients with a mean age of 54.4 years were included. The mean follow-up time was 14 ± 2.5 months, and the average time to bone union was 16 ± 4.3 weeks. There were no wound infections, loss of reduction, fracture nonunion, implant failure, or skin irritation expect for one nail back-out because of osteoporosis. We have reported good results using ESINs for the displaced fractures of the humerus in the four indication adults who would not be able to tolerate plate fixation or intramedullary nailing. The ESINs fixation method is a simple procedure that provides a small incision, minimal blood loss, short surgical time, and relative stability fixation.

Monitoring response to conventional treatment in children with XLH: Value of ALP and Rickets Severity Score (RSS) in a real world setting.

X-linked hypophosphataemia (XLH) is conventionally managed with oral phosphate and active vitamin D analogues. To evaluate long term treatment response by assessing biochemical disease activity [serum alkaline phosphatase (ALP)], radiological rickets severity score (RSS), growth and morbidity in patients with XLH on conventional therapy and assess the correlation between serum ALP and RSS. XLH patients from 3 UK tertiary centres with ≥3 radiographs one year apart were included. Data was collected retrospectively. The RSS was assessed from routine hand and knee radiographs and ALP z scores were calculated using age-specific reference data. Thirty-eight (male=12) patients met the inclusion criteria. The mean±SD knee, wrist and total RSS at baseline (median age 1.2years) were 2.0±1.2, 1.9±1.2 and 3.6±1.3 respectively; and at the most recent clinic visit (median age 9.0years, range 3.3-18.9) were 1.6±1.0, 1.0±1.0 and 2.5±1.5 respectively. The mean±SD serum ALP z scores at baseline and the most recent visit were 4.2±2.3 and 4.0±3.3. Median height SDS at baseline and most recent visit were -1.2 and -2.1 (p=0.05). Dental abscess, craniosynostosis, limb deformity requiring orthopaedic intervention and nephrocalcinosis were present in 31.5%, 7.9%, 31.6% and 42.1% of the cohort respectively. There was no statistically significant (p>0.05) correlation between ALP z scores and knee (r=0.07) or total (r=0.12) RSS. Conventional therapy was not effective in significantly improving biochemical and radiological features of disease. The lack of association between serum ALP and rickets severity on radiographs limits the value of ALP as the sole indicator of rickets activity in patients receiving conventional therapy.

Intraoperative Computer Vision Integrated Interactive Fluoroscopy Correlates With Successful Femoroplasty on Clinic-Based Radiographs

To quantitatively evaluate computer vision interface (CVI)-guided femoroplasty in the arthroscopic treatment offemoroacetabular impingement syndrome and compare those results with traditional unguided resections. Consecutive patients undergoing hip arthroscopy for femoroacetabular impingement syndrome between July 2019 and October 2019 were evaluated. Cases with CVI were identified along with controls, consisting of patients from the same study period who underwent surgery without the CVI and were balanced for age, sex, laterality, and preoperative alpha angles. Alpha angles were measured on pre- and postoperative clinic radiographs, as well as intraoperatively for the CVI group. Cam resections were quantified by measuring pre- and postresection alpha angles and compared between groups. The correlation between CVI views and office-based radiographs was assessed, and the 3 CVI views that best correlated with each of the 3 standard clinic radiographs were evaluated for accuracy and performance in detection of cam deformity with alpha angle ≥48° with the clinic-based films as the reference. A total of 49 patients (51 hips) (average age, 28.7; 33 female patients) in the CVI group, and 51 patients (51 hips) (average age: 29.9; 35 female patients) in the control group. There were no significant differences between groups with respect to age, sex, laterality, or preoperative alpha angle (all P > .05). Significant alpha angle reduction occurred on all intraoperative and postoperative clinic views (all P < .01). The CVI views that best correlated with the clinic radiographs were 11:45 with the anteroposterior (ρ= 0.588, P= .0025), 12:30 with the Dunn lateral (ρ= 0.632, P= .0009), and 1:45 with the false-profile (ρ= 0.575, P= .0033). Greater reliability was observed with 12:30/Dunn (accuracy= 83.33%, P < .0001; sensitivity= 77.14%; specificity= 87.76%) and 1:45/false-profile (accuracy= 82.35%, P= .0051; sensitivity= 81.82%; specificity= 82.61%) than with 11:45/anteroposterior (accuracy= 69.15%, P= .0077; sensitivity= 56.10%; specificity= 79.25%). CVI-guided cam resection results in successful resection of proximal femur cam lesions and represents a femoroplasty templating method that does not require preoperative computed tomography imaging or additional invasive intraoperative referencing modules. The accuracy and adequacy of this resection was validated by comparison with routine clinic radiographs. Therapeutic Level III: retrospective comparative analysis.

Progression of Tibia Fracture Healing Using RUST: Are Early Radiographs Helpful?

To report the progression of radiographic healing after intramedullary nailing of tibial shaft fractures using the Radiographic Union Score for Tibial fractures (RUST) and determine the ideal timing of early postoperative radiographs. Retrospective case series. Urban academic Level 1 trauma center. Three hundred three patients with acute tibial shaft fractures underwent intramedullary nailing between 2006 and 2013, met inclusion criteria, and had at least 3 months of radiographic follow-up. Baseline demographic, injury, and surgical data were recorded for each patient. Each set of postoperative radiographs were scored using RUST and evaluated for implant failure. Postoperative time distribution for each RUST score, RUST score distribution for 4 common follow-up time points, and the presence and timing of implant failure. The fifth percentile and median times, respectively, for reaching "any radiographic healing" (RUST = 5) was 4.0 weeks and 8.4 weeks, "radiographically healed" (RUST = 9) was 12.1 and 20.9 weeks, and "healed and remodeled" (RUST = 12) was 23.5 weeks and 47.7 weeks. At 6 weeks, 84% of radiographs were scored as RUST ≤ 6 (2 or fewer cortices with callus). No implant failure occurred within the first 8 weeks after surgery, and the indication for all 7 reoperations within this period was apparent on physical examination or immediate postoperative radiographs. The median time to radiographic union (RUST = 9) after tibial nailing was approximately 20 weeks, and little radiographic healing occurred within the first 8 weeks after surgery. Routine radiographs in this period may offer little additional information in the absence of clinical concerns such as new trauma, malalignment, or infection. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Plywood Jig—A New Technique for Root Canal Curvature Measurement

The successful outcome of endodontic treatment is dependent on complete cleaning, shaping as well as three dimensional obturation of the root canal system. A conventional radiograph is a two-dimensional replication of a three-dimensional object and does not provide any conclusive evidence for canal curvatures. An accurate knowledge of the tooth anatomy and curvature is essential to avoid procedural errors. 100 freshly extracted human teeth were used in this study. Digital images were obtained using the plywood JIG and Schneider’s technique. These images were analyzed using the VixWin Pro digital image analyzing software (Gendex system). Statistical analysis was done using paired t test. The canal curvature average values measured using Jig method and Schneider method for mandibular teeth are 28.23° (±9.96) and 22.07° (±9.46) respectively. The smallest/largest curvature angles measured using Jig method and Schneider technique are 12/52° and 8/44° respectively. Canal curvature average values measured using Jig method and Schneider method for maxillary teeth were 23.40° (±11.36) and 19.23° (±11.94) respectively. The smallest/largest average curvature angles measured using Jig method, Schneider technique were 9/70° and 5/72° respectively. The values of the canal curvature angle obtained during routine radiographs in clinics have lower curvature angle and higher radius values as compared to the values obtained by this innovative JIG technique. Therefore, a clinician should always keep in mind the difference while measuring the curvature angle on radiographs during root canal treatment.

Imaging of Canine Neoplastic Reproductive Disorders

Simple SummaryThe diagnosis of canine reproductive neoplasia remains challenging as none of the routinely performed diagnostic methods appear to have sufficient sensitivity or specificity. In recent years, advanced imaging techniques have been successfully performed in small animals; however, even though the incidence of reproductive neoplasia is high, no data are available on the performance of these techniques. This review evaluates the applicability of various diagnostic imaging modalities in dogs and describes the findings and specific patterns that may characterise different tumour types. Lamentably, some of the advanced imaging techniques have not yet been adopted as first-line diagnostic tools, although it is clear that in the future they will become important methods for the detection of male and female reproductive neoplasia.Diagnostic imaging plays an essential role in the diagnosis and management of reproductive neoplasia in dogs and cats. The initial diagnosis, staging, and planning of surgical and radiation treatment and the response to therapy all involve imaging to varying degrees. Routine radiographs, ultrasound, nuclear medicine, and cross-sectional imaging in the form of computed tomography (CT) and magnetic resonance imaging (MRI) are routinely used in canine reproductive disorders. The choice of imaging modality depends on many factors, including the level of referral and the pathological information required. The biological behaviour of the tumour also guides the choice of imaging in cancer staging, and imaging may play an important role in guiding serial tumour biopsy during the course of therapy. The sophistication of imaging modalities is increasing exponentially. Each modality has advantages and disadvantages in terms of cost, availability, sensitivity, specificity, and qualities of anatomic versus functional imaging.

Walking Molar – A radiographic Presentation

&#x0D; Dilaceration is the result of a developmental anomaly in which there has been an abrupt change in the axial inclination between the crown and the root of a tooth. It is seen involving both the permanent and primary dentitions. Root canal curvatures may be apical, gradual, sickle-shaped, severe-moderate-straight curve, bayonet / S-shaped curve and dilacerated curve. Curved root canals exhibit great difficulty in cleaning, shaping and obturation of the root canal system. This mandates routine periapical radiographs which aid the clinician in assessing these morphological variations in the root canal system. This article highlights a rare presentation of dilacerated distal root of left mandibular first molar resembling radiographically as walking molar in 17-year-male patient.&#x0D;

Surgical hip dislocation for treatment of synovial chondromatosis of the hip.

In the present study, we aimed to evaluate the clinical outcomes of surgical hip dislocation in patients with synovial chondromatosis (SC) of the hip. Seven patients with primary SC of the hip treated with open synovectomy and removal of loose bodies by surgical hip dislocation from 2016 to 2019 were retrospectively reviewed. All patients had numerous and widespread loose bodies based on pre-operative images, including routine radiographs, CT, and MRI. The visual analog scale (VAS) score and Harris hip score (HHS) were collected and analyzed before and after surgery. The post-operative radiographs were reviewed to evaluate disease recurrence and osteoarthritis progression. The mean operative time was 61 minutes(range, 42-75min). An average of 33 loose bodies in each patient (range, 16-67) was removed, and extra-articular pathology was found in one patient. Patients were followed up for a mean duration of 30months (range, 18-42months). The average VAS scores were decreased from 3.7 (range, 2-6) pre-operatively to 0.9 (range, 0-2) at the last follow-up, and the HHS was improved from 60.1 (range, 50-73) to 90.1 (range, 82-95). All results demonstrated significant improvements (P < 0.05). Post-operative radiographs showed no recurrence, osteoarthritis progression, or osteonecrosis of the femoral head in all hips. Surgical hip dislocation was a practical approach for managing both intra-articular and extra-articular pathologic lesions around the hip. It was an effective treatment for SC of the hip with short surgical time, good joint functions, a lower recurrence rate, and few complications.

Is There a Need for Recovery Room Radiographs Following Uncomplicated Primary Total Knee Arthroplasty?

IntroductionTotal knee arthroplasty (TKA) is one of the most common orthopedic procedures performed in the United States. Obtaining radiographs in the post-anesthesia care unit (PACU) has been the standard of care at most hospitals. The purpose of this study was to examine the utility and cost-effectiveness of immediate, postoperative radiographs in regards to operative decision-making to prevent complications within 90 days after primary TKA.MethodsA retrospective review of 4,830 consecutive patients who underwent cemented or uncemented TKA between January 2016 and June 2019 at a large, regional medical center was performed. International Classification of Diseases, Tenth Revision (ICD-10) codes were used to track any readmissions within 90 days of TKA. If readmission was for a mechanical complication, including fracture, dislocation, or component loosening, PACU radiographs were reviewed for any abnormalities that may have prevented readmission.ResultsThere were 195 readmissions (195 patients), of which 17 were due to mechanical complications. There was no evidence of fracture or abnormality appreciated on any of the reviewed PACU radiographs by either the reading radiologist or the senior authors. Assuming all fractures were noted on immediate, postoperative radiographs, the cost associated with identifying a single fracture in 2,415 patients was $1,072,260.ConclusionRoutine radiographs in the recovery room after an uncomplicated primary TKA are not a reliable mechanism for preventing mechanical complications and do not alter patient care.

3D-printed models for periacetabular osteotomy surgical planning.

The purpose of this study was to determine the feasibility and clinical benefits of using 3D-printed hemipelvis models for periacetabular osteotomy preoperative planning in the treatment of hip dysplasia. This retrospective study included 28 consecutive cases in 26 patients, with two bilateral cases, who underwent periacetabular osteotomy between January 2017 and February 2020 and had routine radiographs, CT and MR imaging. Of these, 14 cases [mean patient age 30.7 (SD 8.4) years, 11 female] had routine preoperative imaging, and 14 cases [mean patient age 28.0 (SD 8.7) years, 13 female] had routine preoperative imaging and creation of a full-scale 3D-printed hemipelvis model from the CT data. The expected surgical cuts were performed on the 3D-printed models. All patients underwent Bernese periacetabular osteotomy. Operative times, including time to achieve proper acetabular position and total periacetabular osteotomy time, fluoroscopy radiation dose and estimated total blood loss were compiled. ANOVA compared outcome variables between the two patient groups, controlling for possible confounders. On average, patients who had additional preoperative planning using the 3D-printed model had a 5.5-min reduction in time to achieve proper acetabular position and a 14.5-min reduction in total periacetabular osteotomy time; however, these changes were not statistically significant (P = 0.526 and 0.151, respectively). No significant difference was identified in fluoroscopy radiation dose or total blood loss. Detailed surgical planning for periacetabular osteotomy using 3D-printed models is feasible using widely available and affordable technology and shows promise to improve surgical efficiency.

The application of an allogeneic bone screw for osteosynthesis in hand and foot surgery: a case series

IntroductionThe allogeneic bone screw transplant is a new osteosynthesis device making the use of foreign fixation material obsolete for various kinds of indications. Moreover, it is integrated into the recipient bone by natural bone remodeling without harming the surrounding tissue. The aim of this study was to determine the efficacy and safety of the transplant for osteotomy and arthrodesis in hand and foot surgery and to evaluate the clinical importance of the device.Materials and methodsA single-surgeon case series of 32 patients who had undergone hand or foot surgery with the application of an allogeneic bone screw with an average follow-up time of 1 year is reported. Clinical data were reviewed to evaluate the pain levels and satisfaction of the patients and the frequency and type of complications occurring during the healing process. Routine radiography and computed tomography were reviewed to determine the fusion rate, the ingrowth behavior of the transplant and the possible occurrence of transplant failure.ResultsHigh patient satisfaction was paired with low postoperative pain levels and a low complication rate. 97% of the patients were free of pain at the timepoint of the second follow-up examination, the mean time of recovery of full mobility was 50.1 ± 26.1 days after surgery. Wound healing disturbance occurred only in two cases. Bony consolidation of the osteotomy or arthrodesis gap as well as osseointegration of the transplant was seen in all cases. No transplant failure or transplant loosening occurred.ConclusionsThe application of the allogeneic bone screw resulted in a 100% fusion rate while the patient burden was low. The transplant is safe and suited for various kinds of osteosynthesis in hand and foot surgery.

STAFNE BONE CYST OF MANDIBLE - A RARE PSEUDOCYST

Background: Stafne bone cyst (SBC) is a bone depression found on the lingual side of the mandible. It is usually asymptomatic and is usually diagnosed on the routine radiographs as an incidental nding. So it has an unknown prevalence. The lesion resembles many odontogenic pathologies and the entity remains a diagnostic challenge. The aim of this case report is to describe the clinical and radiological characteristics of a case of stafne bone cyst and the importance of cone beam computed tomography in conrming the diagnosis. Method: Analysis of orthopantomogram (OPG) and cone beam computed tomography (CBCT) was done on the basis of diagnostic criteria described by Stafne. Result : According to the clinical and radiographic ndings and based on the dental literature, it was concluded that the observed bony cavity was a Stafne bone defect, located in the angle of mandible below inferior alveolar canal. Conclusion: Differential diagnosis of SBC's from other possible pathologies that may require treatment and imaging technique selection according to case is signicant. The use of CBCT is highlighted because of the ne detail of imaging , low radiation dose and limited area exposure which is benecial for the diagnosis of SBC.