Radiographic Screening Research Articles

Assessment of stifle effusion-synovitis as a predictor for canine cruciate disease

Objective: To objectively quantify stifle effusion-synovitis in dogs with confirmed cranial cruciate ligament (CrCL) disease, with or without meniscal pathology, through radiographic assessment by investigating an association between severity of effusion-synovitis and cruciate and meniscal disease, and to establish a standardised quantitative radiographic measurement screening tool to predict severity of cruciate and meniscal injury. Methods: A total of 100 diseased stifles met the inclusion criteria and were assigned to either partial CrCL tear (PT), complete CrCL tear (CT), partial CrCL tear with meniscal pathology (PTM) or complete CrCL tear with meniscal pathology (CTM) groups. Quantitative measurement assessment was then performed to evaluate the percentage of cranial effusion-synovitis (CrES), caudal effusion-synovitis (CdES) and cranial fat pad compression. Three surgeons conducted a blinded review of 15 mediolateral stifle radiographs and were instructed to subjectively and quantitatively predict the degree of cruciate and meniscal pathology. Results: A significant difference of CrES between CT and PT groups (P=0.0173) and CTM and PT (P=0.0169) groups was identified. A significant difference in CdES between PT and CT groups (P=0.0015), PT and CTM groups (P=0.0041) and CTM and CT (P=0.0005) groups was identified. Quantitative measurement demonstrated improved sensitivity, specificity and agreement when compared to subjective assessment. Clinical significance: The results of this study propose that a quantitative radiographic measuring tool for predicting the severity of cruciate and meniscal disease may improve diagnosis of stifle pathology in a clinical setting and aid in pre-operative clinician decision making compared to subjective classification schemes.

P-794. An eight-year experience of active case-finding for tuberculosis cases using mass chest radiography among prisoners in Songkhla Province, Thailand

Abstract Background Thailand is classified by the World Health Organization (WHO) as a high tuberculosis-burden country with an expected that there are 120,000 TB incidences per year in 2016. Reported cases of tuberculosis among prisoners may account for 30% of tuberculosis with an incidence of 880-5,803 cases per 100,000 inmates in low- to middle-income countries. Beginning in 2017, an active case–finding strategy for tuberculosis was implemented in all prisons in Thailand. Mass chest radiograph screening is performed on all prisoners to identify and bring into treatment tuberculosis cases as soon as possible. Incidence of pulmonary tuberculosis among prisoners in Songkhla Province in the South of Thailand 2016-2023 Methods A retrospective descriptive study was conducted at Songkhla Provincial Hospital between 2016 and 2023. Inmates from four prisons in Songkhla Province were assessed by tuberculosis screening using mass chest radiographs yearly from 2017. If abnormal chest radiography revealed compatibility with tuberculosis, sputum microscopy and sputum GeneXpert were performed. Data were analyzed using descriptive statistics Results After implementing the active case-finding strategy in 2017, the incidence of pulmonary tuberculosis in prisons rose from 584 cases per 100,000 inmates in 2016 to 3,483 per 100,000 inmates in 2019. Then the trend declined to 2,264 per 100,000 inmates in 2021 and 1,982 per 100,000 inmates in 2023. Tuberculosis cases in the prisons accounted for 15% in 2016 and continued to rise to 60% in 2019 then decline to 41% in 2023 of all tuberculosis cases in Songkhla Province. Furthermore, sputum microscopy or GeneXpert detected tuberculosis positive between 10% and 16% of all tuberculosis cases in the four prisons. The rates of treatment success were 90%-94% and the case fatality rates were 11-58 cases per 100,000 inmates at the four prisons. Conclusion The active case-finding strategy using mass chest radiography increases the early detection of tuberculosis cases and early treatment in prisons. After 3 years of implementing strategies, the incidence of pulmonary tuberculosis has declined Disclosures All Authors: No reported disclosures

Halide perovskites, a game changer for future medical imaging technology.

The accurate detection of x-rays enables broad applications in various fields, including medical radiography, safety and security screening, and nondestructive inspection. Medical imaging procedures require the x-ray detection devices operating with low doses and high efficiency to reduce radiation health risks, as well as expect the flexible or wearable ones that offer more comfortable and accurate diagnosis experiences. Recently, halide perovskites have shown promising potential in high-performance, cost-effective x-ray detection owing to their attractive features, such as strong x-ray absorption, high-mobility-lifetime product, tunable bandgap, fast response, as well as low-cost raw materials, facile processing, and excellent flexibility. In this review, we comprehensively summarize the recent advances in halide perovskite x-ray detectors and imaging, focusing on their application potential in medical imaging technology. We highlight the recent demonstrations and optimizations of halide perovskite x-ray detectors and imaging and their application in medical radiography. Finally, we conclude by pointing out the challenges of perovskite x-ray detection devices for the clinical practical applications and by sharing our perspectives on the potential solutions for driving the field forward.

Understanding the Prevalence of Medial Arterial Calcification Among Complex Reconstructive Patients: Insights from a Decade of Experience at a Tertiary Limb Salvage Center.

Background: Medial arterial calcification (MAC), a distinct form of vascular pathology frequently coexisting with peripheral arterial disease (PAD), poses unique challenges in limb salvage among patients with diabetes, chronic kidney disease, and end-stage renal disease. This study examines the incidence of MAC and its impact on limb salvage outcomes over a decade of experience at a tertiary limb salvage center. Methods: A retrospective review of all complex lower extremity (LE) reconstructions using local flap (LF) or free tissue transfer (FTT), performed from July 2011 to September 2022, was conducted. Patients were classified into MAC and No MAC groups based on pedal radiography evaluations using the Ferraresi MAC scoring system. The primary outcomes were major lower extremity amputation (MLEA), the need for postoperative vascular intervention, major adverse limb events (MALE; defined as the composite of any unplanned reoperation, MLEA, or postoperative revascularization attempt), and mortality. Results: During the study period, a total of 430 LE reconstructions were performed with LF or FTT. A total of 323 cases (75.1%) demonstrated no MAC while the remaining 107 (24.9%) demonstrated MAC. The MAC group exhibited significantly higher rates of diabetes, PAD, and renal disease. With a follow-up duration of 17.0 (IQR: 33.9) months, the MAC group demonstrated a significantly higher rate of MLEA (24.3% vs. 13.0%, p = 0.006), postoperative vascular intervention (23.4% vs. 8.7%, p < 0.001), MALE (57.0% vs. 25.7%, p < 0.001), and mortality (28.0% vs. 9.9%, p < 0.001). Multivariate analysis identified MAC as independently predictive of MALE (OR: 1.8, CI: 1.1-3.0, p = 0.033). Conclusion: MAC is prevalent among surgical candidates for limb salvage. Patients with MAC represent a significant medical and reconstructive challenge. Radiographic screening for MAC should be considered in all limb salvage candidates with LE wounds, especially in those with diabetes and kidney disease. Assessing MAC is important for better evaluating risk factors and surgical options so as to optimize outcomes in this challenging population.

A Diagnostic Clinical Prediction Rule for Predicting Hip Subluxation/Dislocation in Patients with Cerebral Palsy

OBJECTIVE Hip subluxation/dislocation, a common problem in patients with cerebral palsy (CP), needs to be diagnosed with hip radiography. However, patients with cerebral palsy in a rural or country border areas may not have access to a radiographic screening program due to transportation difficulties and cost. This study aims to develop a clinical prediction rule (CPR) for diagnostic prediction of hip subluxation/dislocation in patients with CP for use as a risk-screening tool. METHODS This is a cross-sectional diagnostic CPR development study. Data were obtained from medical and radiologic records of patients with CP who had undergone outpatient follow-up at a 750-bed general hospital between January 2017 and December 2023. Clinical predictive factors were medical records plus hip subluxation/dislocation diagnoses using the migration percentage (MP), with ≥ 33% indicating hip subluxation and ≥ 90% indicating hip dislocation. Multivariable logistic regression analysis was used for choosing predictive variables and rating their coefficient. Both discriminative and calibration aspects of the performance of the CPR were evaluated using both a development and an internal validity model. RESULTS Among the 69 patients with CP in the study, the mean (SD) age was 113 (242) months. Of the 69 patients, 30 were diagnosed with hip subluxation/dislocation, a prevalence of 43%. Using multivariable logistic regression analysis, a simple CPR performance calibration system was developed which included three factors: age ≥ three years (1 point), female sex (1 point), non-ambulatory status (Gross Motor Function Classification System (GMFCS) levels IV and V) (2 points). The discriminative ability of the CPR, evaluated using the area under the receiver operating characteristic curve (AuROC), was 0.776 (95%CI: 0.668-0.884) and the calibration curve showed acceptable performance in both the development and the internal validation models. CONCLUSIONS Our diagnostic CPR for predicting hip subluxation/dislocation in patients with CP provides acceptable discriminative and calibration performance. This CPR may be used to evaluate the risk of hip subluxation/dislocation in settings where hip radiography is not available. Further external validation studies are needed to confirm the robustness of the performance before applying this CPR in other clinical settings. KEYWORDS cerebral palsy, hip subluxation, hip dislocation, clinical prediction rule

Interventions and implementation considerations for reducing pre-treatment loss to follow-up in adults with pulmonary tuberculosis: A scoping review.

Tuberculosis (TB) is a leading cause of death worldwide with over 90% of reported cases occurring in low- and middle-income countries (LMICs). Pre-treatment loss to follow-up (PTLFU) is a key contributor to TB mortality and infection transmission. We performed a scoping review to map available evidence on interventions to reduce PTLFU in adults with pulmonary TB, identify gaps in existing knowledge, and develop a conceptual framework to guide intervention implementation. We searched eight electronic databases up to February 6 2024, medRxiv for pre-prints, and reference lists of included studies. Two review authors independently selected studies and extracted data using a predesigned form. We analysed data descriptively, presented findings in a narrative summary and developed a conceptual framework based on the Practical, Robust Implementation, and Sustainability Model to map the factors for effective intervention implementation. We reviewed 1262 records and included 17 studies. Most studies were randomized controlled trials (8/17, 47%). Intervention barriers included stigma and inadequate resources; enablers included mobile phones and TB testing and results on the same day. We identified eight interventions that reduced PTLFU: treatment support groups; mobile notifications; community health workers; integrated HIV/TB services; Xpert MTB/RIF as the initial diagnostic test; computer-aided detection with chest radiography screening; active linkage to care; and multi-component strategies. Given the variation of healthcare settings, TB programs should consider contextual factors such as user acceptability, political commitment, resources, and infrastructure before adopting an intervention. Future research should utilize qualitative study designs, be people-centred, and include social and economic factors affecting PTLFU.

External abdominal pressure radiography versus survey radiography for the diagnosis of hiatal hernia in brachycephalic dogs

Hiatal hernia (HH) is a common disorder in brachycephalic dogs with upper airway obstruction. The breathing effort results in an exaggerated transdiaphragmatic pressure gradient during inspiration that can displace the gastroesophageal junction causing gastroesophageal reflux. The diagnosis is challenging because the HH usually occurs intermittently and is often missed on survey radiography. In this retrospective study, the application of external abdominal pressure to mimic the transdiaphragmatic pressure gradient during radiographic screening for HH was evaluated in 146 dogs. Hiatal hernia was diagnosed with external abdominal pressure radiographs in 6.8% (10/146 dogs), whereas it was diagnosed via survey radiography in only 2% (3 dogs). In conclusion, the radiographic diagnosis of HH in brachycephalic dogs can be improved by performing external abdominal pressure radiographs.

Distal sagittal forelimb conformation in young Walloon horses: Radiographic assessment and its relationship with osteochondral fragments.

Osteochondral fragments within equine joints are commonly encountered and may predispose to lameness and limitation to sport purposes. Factors leading to this condition include genetic, nutritional and environmental conditions. However, few studies have evaluated the impact of conformation traits and their correlation with osteochondrosis. This study, based on the radiographic screenings of young horses born in Wallonia (266 individuals, 532 forelimbs), evaluated the correlation between foot, fetlock conformations of the front limb, height at the withers and presence of osteochondral fragments. Moreover, for all traits significantly associated with the presence of osteochondral fragments, a Receiver Operator Characteristic (ROC) curve, area under the curve and optimal cut-off value were calculated to predict the occurrence of fragments. Mean dorsal hoof wall angle was 52.36°, dorsal and palmar angle of the third phalanx were respectively 49.83° and 2.99°, and dorsal metacarpophalangeal angle 147.99°. Moreover, the prevalence of upright feet, defined as having an inclined profile of >2° steeper in relation to its contralateral counterpart, was 24%. Increased palmar angle of the distal phalanx was significantly correlated (P < 0.05) with presence of fragments located at the dorso-proximal margin of the proximal phalanx. The associated area under the curve was 0.623 (95% CI: 0528-0.717, P < 0.05) and the optimal cut-off value to predict fragment occurrence was 2.95° (sensitivity 77.3%; specificity 52.9%). Furthermore, the third metacarpal bone diameter of the left forelimb and height at the withers were significantly (P < 0.05) correlated with the presence of osteochondral fragments in general and within tarsocrural and metatarsophalangeal joints specifically. The area under the curve was 0.585 (95% CI: 0.513-0.656, P < 0.05) with an optimal cut-off value of 152.5 cm (sensitivity 85.1%; specificity 31.2%) for height at the withers to predict presence of osteochondral fragment; to predict the occurrence of osteochondral fragment in any joint on the basis of the third metacarpal bone diameter, the area under the curve was 0.595 (95% CI: 0.524-0.667, P <0.05) and the optimal cut-off value 34.9 mm (sensitivity 52.5%; specificity 64.9%). This study provides information about phenotypic traits associated with osteochondral fragments in horses. Although the diagnostic accuracy of these traits to detect osteochondral fragment was limited, the identification of more phenotypic characteristics could, in the future, make it possible to generate models for accurately identifying individuals at high risk of osteochondral fragments on the basis of their phenotype.

Efficacy of Post-Operative X-Rays after Operatively Treated Ankle Fractures: What is their Role?

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are extremely common orthopaedic injuries that frequently require surgical fixation. In the post-operative setting these fractures are routinely monitored with radiographs. However, the utility of routine post-operative imaging in clinically asymptomatic patients is unclear. This study sought to examine how frequently post-operative radiographs result in management changing decisions for operatively treated ankle fractures. We further sought to identify whether the indication for the study would play a role in the clinical utility of the examination. Methods: This was a retrospective study conducted at a single level 1 trauma center. A detailed review of the hospital’s electronic health record was performed. All patients with operatively treated ankle fractures over a two-year period were identified. Patients required at least one post-operative xray for inclusion. Xrays were divided into surveillance xrays and clinically correlated xrays. Surveillance xrays were those obtained in otherwise asymptomatic patients ordered as part of standard clinic workflow. Clinically indicated xrays were defined as any xrays taken outside of the standard workflow or those in which there was a documented concern noted by the patient or provider. To quantify the cost associated with xrays, we performed a cost analysis. A multivariate logistic regression was then performed using patient demographic variables, fracture characteristics (open vs closed, comminution, syndesmotic injury), and whether the study was performed with a clinical concern or as part of standard asymptomatic follow-up screening. Results: A total of 193 patients with 438 xrays met inclusion criteria. Overall, five asymptomatic radiographs were determined to have changed management (1.3% of all asymptomatic xrays), while 18 clinically correlated xrays were determined to have resulted in a change in management or clinical decision making(38.3%). The difference between number of management changing studies between asymptomatic vs clinically driven xrays was significant (p &lt; 0.001). The elimination of all asymptomatic xrays over the study period would have resulted in a savings of 21,825.62 USD per year. In the logistic regression, the only factor found to be significant in predicting a change in management was the presence of a documented clinical concern voiced by the patient (p &lt; 0001). Conclusion: Screening radiographs in clinically asymptomatic patients with operatively managed ankle fractures have a low likelihood (Approx. 1%) of changing management. Such imaging represents costs to the healthcare system, increased time for patients during clinic visits, and radiation exposure. Such studies remain commonplace because of the concern for missed or delayed diagnosis. Future surveillance protocols must strike a careful balance between minimizing unnecessary studies, maximizing early complication detection, and being personalized towards individual patient level factors so as to optimize care and efficiency for both patient and health system.

Incidence of Ipsilateral Femoral Neck and Shaft Fractures in Pediatric and Adolescent Patients

OBJECTIVES: To identify the incidence, patient characteristics, and effectiveness of radiographic screening methods for detecting ipsilateral femoral neck and shaft fractures in pediatric and adolescent trauma patients. METHODS: Design: Retrospective cohort study. Setting: This study was conducted at a tertiary pediatric trauma hospital. Patient Selection Criteria: Patients younger than 18 years treated for a femoral shaft fracture between 2004 and 2018 were reviewed. Pathologic (metabolic bone disease or bone lesion), periprosthetic, and penetrating traumatic femoral shaft fractures were excluded. Outcome Measurements and Comparisons: Patient demographics, mechanisms of injury, treatment methods, and associated injuries were analyzed. Pretreatment x-rays and computed tomography (CT) scans were reviewed for the identification of ipsilateral femoral neck and shaft fractures. RESULTS: Among the 840 pediatric patients included in this study, 4 patients (0.5%) sustained ipsilateral femoral neck and shaft fractures. All the femoral neck fractures were observed in adolescents (aged 13–17 years) and involved in high-energy traumas. In adolescents involved in high-energy trauma, the incidence increased to 1.7%. Pretreatment sensitivity of both x-rays and CT scans was only 50% for the detection of femoral neck fractures. CONCLUSIONS: This study reveals that ipsilateral femoral neck and shaft fractures in pediatric patients are rare, occurring in adolescents involved in high-energy trauma. The findings suggest the need for a selective, rather than routine, use of CT scans based on the patient's age and the mechanism of injury. The use of alternative imaging methods such as magnetic resonance imaging should be considered to balance diagnostic accuracy while minimizing radiation exposure. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Congenital Syphilis With Multiple Bone Fractures

We report a rare case of multiple fractures occurring in a 3-month-old boy with congenital syphilis (CS). His mother was diagnosed by a gynecologist with syphilis on a screening test before his birth. After birth, a serological panel revealed positive rapid plasma reagin and treponema pallidum hemagglutination assay test results. On the first visit, his left humerus was broken. Whole-body screening radiographs showed multiple fractures of both distal radii and the right first metatarsal. Immobilization was performed with a plastic splint, and callus formation of his humerus was seen after 3 weeks. CS cases have been increasing both in Japan and abroad in recent years. Orthopaedic surgeons should not forget the possibility of CS as a differential for fractures, especially in infants younger than 3 months born to syphilis-infected mothers.

Automated Screening of Hip X-rays for Osteoporosis by Singh's Index Using Machine Learning Algorithms.

Osteoporosis is a significant and growing global public health problem, projected to increase in the next decade. The Singh Index (SI) is a simple, semi-quantitative evaluation tool for diagnosing osteoporosis with plain hip radiographs based on the visibility of the trabecular pattern in the proximal femur. This work aims to develop an automated tool to diagnose osteoporosis using SI of hip radiograph images with the help of machine learning algorithms. We used 830 hip X-ray images collected from Indian men and women aged between 20 and 70 which were annotated and labeled for appropriate SI. We employed three state-of-the-art machine learning algorithms-Vision Transformer (ViT), MobileNet-V3, and a Stacked Convolutional Neural Network (CNN)-for image pre-processing, feature extraction, and automation. Each algorithm was evaluated and compared for accuracy, precision, recall, and generalization capabilities to diagnose osteoporosis. The ViT model achieved an overall accuracy of 62.6% with macro-averages of 0.672, 0.597, and 0.622 for precision, recall, and F1 score, respectively. MobileNet-V3 presented a more encouraging accuracy of 69.6% with macro-averages for precision, recall, and F1 score of 0.845, 0.636, and 0.652, respectively. The stacked CNN model demonstrated the strongest performance, achieving an accuracy of 93.6% with well-balanced precision, recall, and F1-score metrics. The superior accuracy, precision-recall balance, and high F1-scores of the stacked CNN model make it the most reliable tool for screening radiographs and diagnosing osteoporosis using the SI.

Nineteen years of radiographic screening: Impact of sepsis and evolution of osteochondrosis dissecans prevalence in Walloon sport horses born between 2004 and 2022.

Osteochondrosis dissecans is a particularly common developmental orthopaedic disorder in equines. Among its causes, the hereditary component is no longer a matter of debate, and, for several decades, the various studbooks for sport horses have been selecting stallions in order to limit the prevalence of this condition in the population. However, to our knowledge, no study has evaluated changes in the prevalence of osteochondrosis dissecans over time through longitudinal monitoring of a population of sport horses. The study presented here is part of a large screening programme for developmental orthopaedic pathologies in Wallonia (Belgium) and assessed the presence of these lesions over a period of 19 years in the Walloon sport horse population according to constant and standardised sampling and diagnostic criteria. The effects of breeding conditions and infection in foals were also assessed by means of questionnaires. The results showed no significant change in the prevalence of osteochondrosis dissecans in a population of 1099 individuals born between 2004 and 2022. Furthermore, individuals who had suffered from sepsis during their growing period were very significantly predisposed (p < 0.001) to the development of osteochondrosis dissecans compared to a control group, with respectively 14/21 (67%) and 103/364 (28%) of individuals affected. This study suggests that the selection programmes applied to the population studied are not sufficiently strong or adapted to reduce the prevalence of osteochondrosis dissecans in the population over a period of 19 years. Moreover, this study confirms that foals with sepsis and concurrent osteochondrosis dissecans lesions should not necessarily be excluded from breeding programmes on this basis.

Automated estimation of thoracic rotation in chest X-ray radiographs: a deep learning approach for enhanced technical assessment.

This study aims to develop an automated approach for estimating the vertical rotation of the thorax, which can be used to assess the technical adequacy of chest X-ray radiographs (CXRs). Total 800 chest radiographs were used to train and establish segmentation networks for outlining the lungs and spine regions in chest X-ray images. By measuring the widths of the left and right lungs between the central line of segmented spine and the lateral sides of the segmented lungs, the quantification of thoracic vertical rotation was achieved. Additionally, a life-size, full body anthropomorphic phantom was employed to collect chest radiographic images under various specified rotation angles for assessing the accuracy of the proposed approach. The deep learning networks effectively segmented the anatomical structures of the lungs and spine. The proposed approach demonstrated a mean estimation error of less than 2° for thoracic rotation, surpassing existing techniques and indicating its superiority. The proposed approach offers a robust assessment of thoracic rotation and presents new possibilities for automated image quality control in chest X-ray examinations. This study presents a novel deep-learning-based approach for the automated estimation of vertical thoracic rotation in chest X-ray radiographs. The proposed method enables a quantitative assessment of the technical adequacy of CXR examinations and opens up new possibilities for automated screening and quality control of radiographs.

Endodontic radiography - what’s displaying the radiograph? The yield of commercial computer screens vs. DICOM calibrated medical screens in endodontic radiography

ObjectiveA comparison between commercial computer screens and DICOM-calibrated medical screens for characterizing anatomy and diagnosing dental pathologies was performed. The aim of this study was to evaluate and compare the ability of each of those screens to identify root apices and widening of the periodontal ligament (PDL) in the posterior maxillary area.Materials and MethodsDigital X-ray images of 53 maxillary molar teeth were examined by means of a commercial computer screen and again two months later with a DICOM screen to compare their ability to help identify and diagnose PDL widening and to locate the root apices of those teeth.ResultsThe DICOM screen had a significantly better ability to identify widened PDLs (from 31.4% to 34.8% of the cases compared to 19% to 26.1% for the commercial screens, P < .001), depending upon the observer. The DICOM screen was also significantly superior in depicting the root apices compared to the commercial screens (from 77.4% to 83.6% of the cases compared to 56% to 66.7% for the commercial screens, P < 0.001), depending upon the observer.ConclusionDICOM-calibrated medical screens were significantly superior to commercial computer screens for identifying widened PDLs and locating the root apex in the posterior maxillary area.

Deformity Considerations in Cervical Laminoplasty: A Narrative Review.

We discuss the incidence of postoperative kyphosis following laminoplasty and its impact on outcomes, as well as critical radiographic parameters, intraoperative technical factors, and postoperative protocols that can be used to improve results. When appropriately selected, cervical laminoplasty is a motion-sparing treatment option for cervical myelopathy and is a valid alternative to laminectomy and fusion procedures. However, like other posterior-based cervical decompression techniques, laminoplasty can cause postoperative kyphosis. A PubMed search was performed to gather articles that focus on cervical deformity in the context of cervical laminoplasty. The reported conversion rates of lordotic to kyphotic cervical alignment after laminoplasty range from 5.2% to 11.3%. Kyphosis likely reduces the benefit from the operation as measured by postoperative mJOA scores. A surgeon can minimize the risk of causing a clinically significant reduction in lordosis by screening out patients with certain radiographic characteristics. Intraoperative decisions such as dissection techniques, levels chosen, and hybrid constructs can preserve the cervical tension band. Certain postoperative protocols can improve cervical posture. Cervical laminoplasty is an effective tool for treating degenerative cervical myelopathy. Careful radiographic screening, intraoperative decision-making, and postoperative protocols can minimize the development of postoperative cervical deformity and improve outcomes. Level V.

Craniosynostosis: A Pictorial Review

Craniosynostoses are a mixed group of disorders affecting the pediatric skull, resulting from the early fusion of ≥1 cranial suture, leading to protean clinical manifestations. The radiologist must be familiar with nonsyndromic craniosynostosis, syndromic craniosynostosis and associated abnormalities, secondary craniosynostosis, and mimics of craniosynostosis, including deformational plagiocephaly. This review explores the radiologic and clinical presentation of these diseases as well as the imaging work-up, including screening radiography, ultrasound, CT, and MRI evaluation.Learning Objective: To understand the various types of craniosynostosis and their classic imaging appearances through knowledge of basic cranial sutural anatomy and cranial growth patterns.

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study

Cervical spine injuries in children are uncommon but potentially devastating; however, indiscriminate neck imaging after trauma unnecessarily exposes children to ionising radiation. The aim of this study was to derive and validate a paediatric clinical prediction rule that can be incorporated into an algorithm to guide radiographic screening for cervical spine injury among children in the emergency department. In this prospective observational cohort study, we screened children aged 0-17 years presenting with known or suspected blunt trauma at 18 specialised children's emergency departments in hospitals in the USA affiliated with the Pediatric Emergency Care Applied Research Network (PECARN). Injured children were eligible for enrolment into derivation or validation cohorts by fulfilling one of the following criteria: transported from the scene of injury to the emergency department by emergency medical services; evaluated by a trauma team; and undergone neck imaging for concern for cervical spine injury either at or before arriving at the PECARN-affiliated emergency department. Children presenting with solely penetrating trauma were excluded. Before viewing an enrolled child's neck imaging results, the attending emergency department clinician completed a clinical examination and prospectively documented cervical spine injury risk factors in an electronic questionnaire. Cervical spine injuries were determined by imaging reports and telephone follow-up with guardians within 21-28 days of the emergency room encounter, and cervical spine injury was confirmed by a paediatric neurosurgeon. Factors associated with a high risk of cervical spine injury (>10%) were identified by bivariable Poisson regression with robust error estimates, and factors associated with non-negligible risk were identified by classification and regression tree (CART) analysis. Variables were combined in the cervical spine injury prediction rule. The primary outcome of interest was cervical spine injury within 28 days of initial trauma warranting inpatient observation or surgical intervention. Rule performance measures were calculated for both derivation and validation cohorts. A clinical care algorithm for determining which risk factors warrant radiographic screening for cervical spine injury after blunt trauma was applied to the study population to estimate the potential effect on reducing CT and x-ray use in the paediatric emergency department. This study is registered with ClinicalTrials.gov, NCT05049330. Nine emergency departments participated in the derivation cohort, and nine participated in the validation cohort. In total, 22 430 children presenting with known or suspected blunt trauma were enrolled (11 857 children in the derivation cohort; 10 573 in the validation cohort). 433 (1·9%) of the total population had confirmed cervical spine injuries. The following factors were associated with a high risk of cervical spine injury: altered mental status (Glasgow Coma Scale [GCS] score of 3-8 or unresponsive on the Alert, Verbal, Pain, Unresponsive scale [AVPU] of consciousness); abnormal airway, breathing, or circulation findings; and focal neurological deficits including paresthesia, numbness, or weakness. Of 928 in the derivation cohort presenting with at least one of these risk factors, 118 (12·7%) had cervical spine injury (risk ratio 8·9 [95% CI 7·1-11·2]). The following factors were associated with non-negligible risk of cervical spine injury by CART analysis: neck pain; altered mental status (GCS score of 9-14; verbal or pain on the AVPU; or other signs of altered mental status); substantial head injury; substantial torso injury; and midline neck tenderness. The high-risk and CART-derived factors combined and applied to the validation cohort performed with 94·3% (95% CI 90·7-97·9) sensitivity, 60·4% (59·4-61·3) specificity, and 99·9% (99·8-100·0) negative predictive value. Had the algorithm been applied to all participants to guide the use of imaging, we estimated the number of children having CT might have decreased from 3856 (17·2%) to 1549 (6·9%) of 22 430 children without increasing the number of children getting plain x-rays. Incorporated into a clinical algorithm, the cervical spine injury prediction rule showed strong potential for aiding clinicians in determining which children arriving in the emergency department after blunt trauma should undergo radiographic neck imaging for potential cervical spine injury. Implementation of the clinical algorithm could decrease use of unnecessary radiographic testing in the emergency department and eliminate high-risk radiation exposure. Future work should validate the prediction rule and care algorithm in more general settings such as community emergency departments. The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Health Resources and Services Administration of the US Department of Health and Human Services in the Maternal and Child Health Bureau under the Emergency Medical Services for Children programme.

Chest Radiograph Screening for Detecting Subclinical Tuberculosis in Asymptomatic Household Contacts, Peru.

The World Health Organization's end TB strategy promotes the use of symptom and chest radiograph screening for tuberculosis (TB) disease. However, asymptomatic early states of TB beyond latent TB infection and active disease can go unrecognized using current screening criteria. We conducted a longitudinal cohort study enrolling household contacts initially free of TB disease and followed them for the occurrence of incident TB over 1 year. Among 1,747 screened contacts, 27 (52%) of the 52 persons in whom TB subsequently developed during follow-up had a baseline abnormal radiograph. Of contacts without TB symptoms, persons with an abnormal radiograph were at higher risk for subsequent TB than persons with an unremarkable radiograph (adjusted hazard ratio 15.62 [95% CI 7.74-31.54]). In young adults, we found a strong linear relationship between radiograph severity and time to TB diagnosis. Our findings suggest chest radiograph screening can extend to detecting early TB states, thereby enabling timely intervention.

Posttraumatic proximal radioulnar synostosis: Current concepts on the clinical presentations, classifications, and open surgical approaches

In the forearm, posttraumatic heterotopic ossification usually forms as a proximal radioulnar synostosis. It can occur after soft tissue injury involving the interosseous membrane or after surgery involving the radio and ulna, such as distal biceps tendon repair. It can also be induced by radial head dislocation or fracture. Screening radiography can be used to select the appropriate time for excision. The synostosis can be resected when the ectopic bone margin and trabeculation appear mature on radiographs. An interval of 6–12 months from the injury is generally recommended based on ectopic bone maturity. Selection of the surgical approach depends on site, extension (elbow joint or proximal radioulnar joint), severity of the initial articular surface, and periarticular tissue injury. The posterolateral approach is indicated for synostoses: at or distal to the bicipital tuberosity, at the level of the radial head, and proximal radioulnar joint. The posterior global approach is recommended when the forearm synostosis is associated with complete bony ankylosis of the elbow involving the distal aspect of the humerus. After surgical resection of a proximal radioulnar synostosis, the exposed bone surfaces can be covered with interposition material to minimize recurrence.