Skeletal Radiographs Research Articles

Comparison of the diagnostic value of low-dose computed tomography of the axial skeleton and skeletal radiography in patients with multiple myeloma

Comparison of the diagnostic value of low-dose computed tomography of the axial skeleton and skeletal radiography in patients with multiple myeloma

Assessing Time to Diagnosis, End-Organ Damage and Treatment Response in Young Newly Diagnosed Multiple Myeloma Patients

Introduction Multiple myeloma (MM) primarily affects older adults, with a median age of 69 years at time of diagnosis. Presenting symptoms of MM are often vague and nonspecific, such as fatigue or musculoskeletal pain, which can delay diagnosis. This may result in irreversible end-organ damage caused by MM, notably renal insufficiency and lytic bone lesions resulting in pathologic fractures, in addition to the reversible anemia and hypercalcemia that are hallmarks of the disease. Those younger than age 50 represent only 5% of patients living with MM. Though they remain in the minority, the incidence in young patients is rising. Data regarding initial presentation, cytogenetics, and rates of end-organ damage are poorly described, and most information arises from individual case reports or small series. In this study, we performed a retrospective analysis of newly diagnosed MM patients at the age of 51 or younger to characterize this distinct population. Methods Patients were identified using automated data capture techniques and manually reviewed. All treatment-eligible patients with MM presenting to UC Davis Medical Center between January 2014 to July 2021 were assessed, regardless of diagnosis date. The diagnosis of multiple myeloma was established according to the IMWG criteria, and patients < 51 years were included. Exclusion criteria included patients with non-histologically confirmed MM. Time of symptom onset was defined as the first medical evaluation with documentation of symptoms or radiographic/laboratory abnormalities which could be ascribed to MM as ascertained through chart review. Baseline diabetes, hypertension and coronary artery disease (comorbidities) were tabulated. Myeloma-related complications were defined as hypercalcemia (serum calcium >11 mg/dL), renal insufficiency (serum creatinine >2mg/dL), anemia (hemoglobin <10g/dL), and bone lesions (one or more osteolytic lesion on skeletal radiography, CT, PET/CT, or MRI) at time of diagnosis. Results 123 patients were included in the study, and their baseline demographics are described in Table 1. The median age was 46.0 years, with a range from 27.8 to 50.9 years; 19 (15%) were age <40. Hypertension was seen in 27 (22%) patients, 7 (5.7%) had diabetes while 93 (74%) had no comorbidities. The most common presenting symptom was musculoskeletal pain 79% of patients. Other presenting manifestations included anemia (13%), fatigue (12%), bacterial infections (8.9%), and weight loss (5.7%). The median time from symptom onset to diagnosis was 1.47 months, with a range of 0 to 49.7 months. Clinical characteristics at diagnosis are described in Table 2. Among the 79 patients with R-ISS staging, 18% had R-ISS Stage I, 70% had Stage II, and 13% had Stage III. Of the 105 patients with cytogenetics data, 19% were high-risk, del(17p) , t(4;14), and/or t(14;16), while 20% had a +1q. For myeloma-related complications, 14 (11%) had hypercalcemia, 16 (13%) renal insufficiency, and 41 (33%) anemia, 95 (77%) of patients had lytic lesions, and 62 (50%) patients presented with fractures. Of these, 31 had spinal compression fractures, 12 had extra-axial pathologic fractures, and 9 had both. Median time from diagnosis to treatment was 0.60 months, with a range of 0 to 23.93 months. The most common induction regimens, received by 64 (52%) of patients, were immunomodulatory drug and proteasome inhibitor combinations. This is followed by CyBorD (20 patients, 16%) and doublet or other therapy (39 patients, 32%). Autologous stem cell transplantation was utilized by 89 (71%) patients, with 19 (15%) receiving a second transplant. The median age at first transplant was 45.7 years, and 49.8 years at second transplant. Conclusion We describe one of the largest cohorts of MM patients diagnosed under the age of 51. While on average we did not observe a significant delay between symptom onset and diagnosis, there were some notable outliers. The presenting symptoms and rates of end-organ damage were similar to what has previously been described in older cohorts, though fractures were more common. Transplant was more frequently used than the general population. Additional study on this population is needed to better understand treatment patterns and barriers to their care. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Pycnodysostosis: Case report

Pycnodysostosis is a rare genetic osteopathy that combines: dysmorphic syndrome, osteocondensation and growth retardation. This is an newborn of 09 months old in whom a pycnodysostosis was suspected, he was referred by a geneticist to look for radiological signs of this disease. He was born in a first degree consanguineous marriage and had been suffering from repeated spontaneous fractures since birth. The examination revealed a facial dysmorphism with macrocephaly, a persistent anterior fontanel, protruding frontal bumps and micrognathia with a curved aspect of the left lower limb. Skeletal radiographs showed densification of the skull base bones, persistence of the anterior fontanel, hypoplasia of the lower jaw bone and several fractures of different ages with bone calluses, diffuse cortical thickening and metaphyseal enlargement with a short aspect of the upper limb bones were found. In view of the clinical signs and radiological manifestations, the diagnosis retained is pycnodysostosis. Orthopedic management was proposed for the family. Pycnodysostosis is a rare disease, sometimes difficult to diagnose and of delayed onset, which poses a differential diagnostic problem with osteopetrosis and osteogenesis imperfecta.

Advances in multiscale image processing and its effects on image quality in skeletal radiography

Multi-frequency processing (MFP) leads to enhanced image quality (IQ) of radiographs. This study is to determine the effect of third generation MFP (M3) on IQ in comparison to standard second-generation MFP (M2). 20 cadavers were examined and post-processing of radiographs was performed with both M2 and M3. Three readers blinded to the MFP used for each image independently compared corresponding image pairs according to overall IQ and depiction of bony structures and soft tissue (+ 2: notably better > 0: equal > − 2: notably worse). A significant deviation of the median grade from grade 0 (equal) (p < 0.01) for each evaluator A, B and C speaks against an equal image quality of M2- and M3-images. M3-images were categorized with better grades (+ 1, + 2) in 87.7% for overall image quality, in 90.4% for soft tissue and 81.8% for bony structures. M3 images showed significant higher averaged SNR and CNR for all investigated lower extremities than that of M2 images (0.031 < p < 0.049). The newest generation of MFP leads to significantly better depiction of anatomical structures and overall image quality than in images processed with the preceding generation of MFP. This provides increased diagnostic accuracy and further decreased radiation exposure.

Accuracy of radiographer preliminary clinical evaluation of skeletal trauma radiographs, in clinical practice at a district general hospital

IntroductionError in interpretation of trauma radiographs by referrers is a problem which has detrimental effects on the patient and causes unnecessary repeat attendances. Radiographers can reduce errors by offering their opinion at the time of imaging. The Society and College of Radiographers have a longstanding recommendation that Red Dot (RD) schemes should be replaced by Preliminary Clinical Evaluation (PCE). The purpose of the study was to evaluate radiographer interpretation of skeletal trauma radiographs in clinical practice, determine if there was any difference in ability to interpret appendicular and axial studies, and evaluate appropriateness of PCE implementation. MethodsA convenience sample of 23 self-selecting radiographers provided RD and PCE on 762 examinations. Each case was compared against the verified report and assigned a true negative/positive or false negative/positive value. Accuracy, sensitivity and specificity were calculated and performance measures between RD versus PCE, and appendicular versus axial were compared using Two-sample Z-Tests. Error analysis was performed and inter-observer consistency determined. ResultsOverall RD and PCE accuracy, sensitivity and specificity for the study were 90%, 72% and 97% (RD), and 92%, 80% and 97% (PCE) respectively. Significant difference was demonstrated for sensitivity with PCE more sensitive than RD (p-value 0.03) and appendicular more sensitive than axial (RD p-value <0.02, PCE p-value <0.0001). Most errors were false negatives. Inter-observer consistency was evaluated by review of 128 cases and no difference between reviewers was established. ConclusionRadiographers without specific training were able to provide RD and PCE to a high standard. Radiographers interpreted positive findings more accurately using PCE than RD, and positive findings on appendicular cases were interpreted more accurately than those on axial cases. Implications for practiceThis study supports local PCE implementation, contributes to the wider evidence base to justify transition towards PCE and identifies the necessity for local axial image interpretation training.

Prenatal Diagnosis of a Lethal Skeletal Dysplasia.

Prenatal Diagnosis of a Lethal Skeletal Dysplasia.

DXA and clinical challenges of fracture risk assessment in primary care.

Dual-energy x-ray absorptiometry (DXA) can detect bone mineral density loss before it can be identified on usual skeletal radiography, making it possible to diagnose osteoporosis in postmenopausal women and older men before clinical fractures arise. However, when DXA is used outside these populations or if the clinical picture does not match the reported T-scores, mistakes can arise in interpreting results and determining the need for pharmaceutical therapy.

FEMORAL-FACIAL SYNDROME - A RARE CASE REPORT

Femoral-facial syndrome (FFS) is an extremely rare fetal malformation. It comprises bilateral femoral hypoplasia and craniofacial dysmorphism. Maternal diabetes is associated with approximately 40% of cases of FFS. We present the case of Femoral-Facial syndrome of Newborn female child. She was delivered by vaginal route at 36th week of gestation. Mother had a history of type 2 diabetes mellitus. She was having markedly shortened bilateral lower limbs, deformed hip joint and mild talipes equino-varus deformity of left foot. There was prominent forehead, short nose with broad tip, long philthrum, thin upper lip, micrognathism and malformed low set external ears. Skeletal radiograph shows complete absence of right femur and marked hypoplasia of left femur.

Tibial Tubercle Apophyseal Stage to Determine Skeletal Age in Pediatric Patients Undergoing ACL Reconstruction: A Validation and Reliability Study.

Background:Anterior cruciate ligament (ACL) injuries demand individualized treatments based on an accurate estimation of the child’s skeletal age. Wrist radiographs, which have traditionally been used to determine skeletal age, have a number of limitations, including cost, radiation exposure, and inconvenience.Purpose:To evaluate the reliability and validity of a radiographic staging system using tibial apophyseal landmarks as hypothetical proxies for skeletal age to use in the preoperative management of pediatric ACL tears.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:The study included children younger than 16 years of age who underwent ACL reconstruction between July 2008 and July 2018 and received both skeletal age radiography and knee radiography within 3 months of each other. Skeletal age was calculated from hand and wrist radiographs using the Greulich and Pyle atlas. Tibial apophyseal staging was categorized into 4 stages: cartilaginous stage (stage 1), apophyseal stage (stage 2), epiphyseal stage (stage 3), and bony/fused stage (stage 4). Data were collected by 2 independent assessors. The analysis was repeated 1 month later with the same assessors. We calculated descriptive statistics, measures of agreement, and the correlation between skeletal age and apophyseal stage.Results:The mean chronological age of the 287 patients included in the analysis was 12.9 ± 1.9 years; 164 (57%) of the patients were male. The overall Spearman r between skeletal age and tibial apophyseal staging was 0.69 (0.77 in males; 0.60 in females). The interrater reliability for the tibial apophyseal staging was substantial (Cohen κ = 0.66), and the intrarater reliability was excellent (Cohen κ = 0.82). The interrater reliability for skeletal age was excellent (intraclass correlation coefficient [ICC] = 0.93), as was the intrarater reliability (ICC = 0.97).Conclusion:The observed correlation between skeletal age and tibial apophyseal staging as well as observed intra- and interrater reliabilities demonstrated that tibial apophyseal landmarks on knee radiographs may be used to estimate skeletal age. This study supports the validity of knee radiographs in determining skeletal age and provides early evidence in certain clinical presentations to simplify the diagnostic workup and operative management of pediatric knee injuries, including ACL tears.

Pegbelfermin, a PEGylated FGF21 analogue, has pharmacology without bone toxicity after 1-year dosing in skeletally-mature monkeys

Pegbelfermin (PGBF) is a PEGylated fibroblast growth factor 21 (FGF21) analogue in development for treatment of nonalcoholic steatohepatitis (NASH). Mouse models highlight potential utility of FGF21 in NASH, but also suggest negative effects on bone, though these findings are confounded by profound FGF21-related decreases in body mass/growth. This study aimed to profile PGBF-related bone effects in adult nonhuman primates after long-term, clinically-relevant exposures. Adult male cynomolgus monkeys received weekly subcutaneous PGBF (0.3, 0.75 mg/kg) or control injections for 1 year (n = 5/group). Assessments included body weight, clinical chemistry, adiponectin levels, bone turnover biomarkers, skeletal radiography, pharmacokinetics, immunogenicity, and histopathology. Bone densitometry and body composition were evaluated in vivo and/or ex vivo with dual-energy x-ray absorptiometry, peripheral quantitative computed tomography, and biomechanical strength testing. After 1 year of PGBF administration, there was clear evidence of sustained PGBF pharmacology in monkeys (peak increase in serum adiponectin of 1.7× and 2.35× pretest at 0.3 and 0.75 mg/kg PGBF, respectively) and decreased body weight compared with control at exposures comparable to those tested in humans. At 0.75 mg/kg PGBF, pharmacologically-mediated reductions in lean mass, lean area, and fat area were observed relative to controls. There were no PGBF-related effects on bone biomarkers, radiography, densitometry, or strength. Together, these data demonstrate that PGBF did not adversely alter bone metabolism, density, or strength following 1 year of dosing at clinically relevant (0.7–2.2× human AUC[0-168 h] at 20 mg once weekly), pharmacologically-active exposures in adult monkeys, suggesting a low potential for negative effects on bone quality in adult humans.

Malignant infantile osteopetrosis with rickets presenting with bicytopenia in septic shock: case report

Malignant infantile osteopetrosis is a rare, fatal autosomal recessive disorder due to abnormal osteoclast activity. We report a 1-year-old infant, born to consanguineously married couple, who presented to our ER with acute respiratory distress and bicytopenia. He had tender hepatomegaly, splenomegaly, failure to thrive and features of rickets. He was evaluated previously for possible hydrocephalus secondary to his abnormal shape of head with proptosis, MRI revealed a subarachnoid cyst, but possibility of osteopetrosis was missed. Skeletal radiographs done later detected dense, sclerotic bone with sandwich vertebra, provided a delayed diagnosis of MIOP. Rickets, a paradoxical association, was also seen in our case, with low serum calcium and vitamin D3 levels. He succumbed due to severe bronchopneumonia with septic shock. Early diagnosis and timely hematopoietic stem cell transplant are the only curative approach for MIOP, which is otherwise fatal.

Reporting errors in plain radiographs for lower limb trauma\u2014a systematic review and meta-analysis

IntroductionPlain radiographs are a globally ubiquitous means of investigation for injuries to the musculoskeletal system. Despite this, initial interpretation remains a challenge and inaccuracies give rise to adverse sequelae for patients and healthcare providers alike. This study sought to address the limited, existing meta-analytic research on the initial reporting of radiographs for skeletal trauma, with specific regard to diagnostic accuracy of the most commonly injured region of the appendicular skeleton, the lower limb.MethodA prospectively registered, systematic review and meta-analysis was performed using published research from the major clinical-science databases. Studies identified as appropriate for inclusion underwent methodological quality and risk of bias analysis. Meta-analysis was then performed to establish summary rates for specificity and sensitivity of diagnostic accuracy, including covariates by anatomical site, using HSROC and bivariate models.ResultsA total of 3887 articles were screened, with 10 identified as suitable for analysis based on the eligibility criteria. Sensitivity and specificity across the studies were 93.5% and 89.7% respectively. Compared with other anatomical subdivisions, interpretation of ankle radiographs yielded the highest sensitivity and specificity, with values of 98.1% and 94.6% respectively, and a diagnostic odds ratio of 929.97.ConclusionInterpretation of lower limb skeletal radiographs operates at a reasonably high degree of sensitivity and specificity. However, one in twenty true positives is missed on initial radiographic interpretation and safety netting systems need to be established to address this. Virtual fracture clinic reviews and teleradiology services in conjunction with novel technology will likely be crucial in these circumstances.

Saturation mutagenesis defines novel mouse models of severe spine deformity.

ABSTRACTEmbryonic formation and patterning of the vertebrate spinal column requires coordination of many molecular cues. After birth, the integrity of the spine is impacted by developmental abnormalities of the skeletal, muscular and nervous systems, which may result in deformities, such as kyphosis and scoliosis. We sought to identify novel genetic mouse models of severe spine deformity by implementing in vivo skeletal radiography as part of a high-throughput saturation mutagenesis screen. We report selected examples of genetic mouse models following radiographic screening of 54,497 mice from 1275 pedigrees. An estimated 30.44% of autosomal genes harbored predicted damaging alleles examined twice or more in the homozygous state. Of the 1275 pedigrees screened, 7.4% presented with severe spine deformity developing in multiple mice, and of these, meiotic mapping implicated N-ethyl-N-nitrosourea alleles in 21% of pedigrees. Our study provides proof of concept that saturation mutagenesis is capable of discovering novel mouse models of human disease, including conditions with skeletal, neural and neuromuscular pathologies. Furthermore, we report a mouse model of skeletal disease, including severe spine deformity, caused by recessive mutation in Scube3. By integrating results with a human clinical exome database, we identified a patient with undiagnosed skeletal disease who harbored recessive mutations in SCUBE3, and we demonstrated that disease-associated mutations are associated with reduced transactivation of Smad signaling in vitro. All radiographic results and mouse models are made publicly available through the Mutagenetix online database with the goal of advancing understanding of spine development and discovering novel mouse models of human disease.

Comparison of reporting radiographers' and medical doctors' performance in reporting radiographs of the appendicular skeleton, referred by the emergency department

IntroductionThere is an increasing trend towards deploying reporting radiographers in Danish hospitals who, among various professional groups, interpret and report skeletal radiographs from the emergency department (ED). This study aimed to compare the quality of the reports issued by reporting radiographers to three different groups of medical doctors (MDs) who interpret or report skeletal radiographs at the ED. MethodsFour professional groups (i.e. four reporting radiographers, two radiology trainees, two orthopaedic senior trainees, and two orthopaedic trainees) reported 100 radiographs of the appendicular skeleton. The Consequence of clinical Outcome score (CO-score), accuracy, sensitivity, and specificity of each group were compared. The relative risk of a false-negative, false-positive or wrong result, the risk of a serious error, as well as the odds ratio of a more severe CO-score for each of the three MD groups, were compared to the reporting radiographers. ResultsThere was a significant difference between the groups in reference to the CO-score (P ≤ 0.001), accuracy (P = .003), specificity (P = .022), and in the proportion of serious errors (P ≤ 0.001). Compared to the reporting radiographers, all three groups of MDs showed a significantly higher CO-score and a significantly increased risk of a wrong result. Moreover, two of the MD groups showed a significantly increased risk of a false-positive result and for severe errors. ConclusionBased on the CO-score, the relative risk of errors, which could potentially cause malpractice in treatment and patient recall, significantly decreased when the reports were completed by reporting radiographers. Implications for practiceTo explore the need for a 24-h radiographer reporting service to the EDs, an upscaled study, like the current, with more participants representing the professional groups is highly recommended.

Image quality is resilient against tube voltage variations in post-mortem skeletal radiography with a digital flat-panel detector

In recent phantom studies low-contrast detectability was shown to be independent from variations in tube voltage in digital radiography (DR) systems. To investigate the transferability to a clinical setting, the lower extremities of human cadavers were exposed at constant detector doses with different tube voltages in a certain range, as proposed in the phantom studies. Three radiologists independently graded different aspects of image quality (IQ) in a comparative analysis. The grades show no correlation between IQ and kV, which means that the readers were not able to recognize a significant IQ difference at different kV. Signal-to-noise and contrast-to-noise ratios showed no significant differences in IQ despite the kV-setting variations. These findings were observed from a limited kV range setting. Higher kV-settings resulted in lowest patient exposure at constant IQ. These results confirm the potential of DR-systems to contribute to standardization of examination protocols comparable to computed tomography. This may prevent the trend to overexpose. Further investigations in other body regions and other DR-systems are encouraged to determine transferability.

The diagnostic performance of chest computed tomography in the detection of rib fractures in children investigated for suspected physical abuse: a systematic review and meta-analysis

ObjectivesTo assess the diagnostic performance of chest CT in the detection of rib fractures in children investigated for suspected physical abuse (SPA).MethodsMedline, Web of Science and Cochrane databases were searched from January 1980 to April 2020. The QUADAS-2 tool was used to assess the quality of the eligible English-only studies following which a formal narrative synthesis was constructed. Studies reporting true-positive, false-positive, true-negative, and false-negative results were included in the meta-analysis. Overall sensitivity and specificity of chest CT for rib fracture detection were calculated, irrespective of fracture location, and were pooled using a univariate random-effects meta-analysis. The diagnostic accuracy of specific locations along the rib arc (anterior, lateral or posterior) was assessed separately.ResultsOf 242 identified studies, 4 met the inclusion criteria. Of these, 2 were included in the meta-analysis. Chest CT identified 142 rib fractures compared to 79 detected by initial skeletal survey chest radiographs in live children with SPA. Post-mortem CT (PMCT) has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures when compared to the autopsy reference standard. PMCT has low sensitivity (45%, 21% and 42%) but high specificity (99%, 97% and 99%) at anterior, lateral and posterior rib locations, respectively.ConclusionsChest CT detects more rib fractures than initial skeletal survey chest radiographs in live children with SPA. PMCT has low sensitivity but high specificity for detecting rib fractures in children investigated for SPA.Key Points• PMCT has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures; extrapolation to CT in live children is difficult.• No studies have compared chest CT with the current accepted practice of initial and follow-up skeletal survey chest radiographs in the detection of rib fractures in live children investigated for SPA.

Assessment of maturation indicators in individuals with different skeletal malocclusion.

The aim of this study was to comparatively evaluate hand-wrist bones, cervical vertebrae and tooth development stages according to skeletal classification. The orthodontic initial records of 297patients were used and separated into three groups according to the skeletal malocclusion. Three groups including 99people each were sampled representing malocclusions with Angle classesI, II and III, respectively. The panoramic, cephalometric and hand-wrist radiographs of all patients included in this study were used to compare dental and skeletal maturation indicators. Calcification of teeth was rated according to the system of Demirjian. To evaluate the stage of skeletal maturation hand-wrist radiographs were analyzed according to the Grave and Brown method. Also, Hassel and the Farman method was used to classifying vertebral developmental stages. Spearman rank correlation tests, as well as Fisher exact χ2 tests with r×c tables, were used for the comparison of categorical variables. Hand-wrist, vertebral and dental development stages showed astatistically significant relationship (p < 0.01) for both genders and in all malocclusions. The association between the different maturation indicators used in this study and the type of malocclusion was also statistically significant for both genders. It was observed that the peak period of skeletal maturation according to the hand-wrist radiograph findings correlated with the cervical vertebrae stage C3 in girls (63.2%) and C2-C3 in boys (43.5-43.5%). The weakest correlation was seen between the dental development stages and the skeletal developmental stages in the classII group (r = 0.443-0.220 [girls]; r = 0.604-0.410 [boys]). The use of the dental development stage as areliable indicator of maturation was limited. According to the Demirjian method, the calcification stage of the second molar might indicate that the individual is in the pubertal peak period.

Clinical utility of postprocessed low-dose radiographs in skeletal imaging.

Objectives:Radiography remains the mainstay of diagnostic and follow-up imaging. In view of the risks and the increasing use of ionizing radiation, dose reduction is a key issue for research and development. The introduction of digital radiography and the associated access to image postprocessing have opened up new opportunities to minimize the radiation dosage. These advances are contingent upon quality controls to ensure adequate image detail and maintenance of diagnostic confidence. The purpose of this study was to investigate the clinical applicability of postprocessed low-dose images in skeletal radiography.Methods:In our study setting, the median radiation dose for full dose X-rays was 9.61 dGy*cm2 for pelvis, 1.20 dGy*cm2 for shoulder and 18.64 dGy*cm2 for lumbar spine exams. Based on these values, we obtained 200 radiographs for each anatomic region in four consecutive steps, gradually reducing the dose to 84%, 71%, 60% and 50% of the baseline using an automatic exposure control (AEC). 549 patients were enrolled for a total of 600 images. All X-rays were postprocessed with a spatial noise reduction algorithm. Two radiologists assessed the diagnostic value of the radiographs by rating the visualization of anatomical landmarks and image elements on a five-point Likert scale. A mean-sum score was calculated by averaging the two reader’s total scores. Given the non-parametric distribution, we used the Mann-Whitney U test to evaluate the scores.Results:Median dosage at full dose accounted for 38.4%, 48 and 53.2% of the German reference dose area product for shoulder, pelvis and lumbar spine, respectively. The applied radiation was incrementally reduced to 21.5%, 18.4% and 18.7% of the respective reference value for shoulder, pelvis and lumbar spine. Throughout the study, we observed an estimable tendency of superior quality at higher dosage in overall image quality. Statistically significant differences in image quality were restricted to the 50% dose groups in shoulder and lumbar spine images. Regardless of the applied dosage, 598 out of 600 images were of sufficient diagnostic value.Conclusion:In digital radiography image postprocessing allows for extensive reduction of radiation dosage. Despite a trend of superior image detail at higher dose levels, overall quality and, more importantly, diagnostic utility of low-dose images was not significantly affected. Therefore, our results not only confirm the clinical utility of postprocessed low-dose radiographs, but also suggest a widespread deployment of this advanced technology to ensure further dose limitations in clinical practice.Advances in knowledge:The diagnostic image quality of postprocessed skeletal radiographs is not significantly impaired even after extensive dose reduction by up to 20% of the reference value.

Clinician and computer: a study on patient perceptions of artificial intelligence in skeletal radiography

BackgroundUp to half of all musculoskeletal injuries are investigated with plain radiographs. However, high rates of image interpretation error mean that novel solutions such as artificial intelligence (AI) are being...

Aches and Pains in a Patient With History of Prostatectomy: Extensive Skeletal Metastasis Picked up by Diffusion-Weighted Magnetic Resonance Imaging

A 64-year-old gentleman presented to the out-patient with complaints of generalized body ache. He had a history of prostate cancer for which robotic radical prostatectomy (RP) was done earlier. The levels of prostate specific antigen (PSA) and alkaline phosphatase (ALP) were significantly elevated. Skeletal radiograph showed only few sclerotic foci. Magnetic resonance imaging whole-body diffusion-weighted image (MRI-WB-DWI) however revealed the presence of diffuse skeletal metastasis. In any elderly male who presents with generalized body pain, eliciting a good history should not be overlooked. With a history of prostate cancer, diffuse metastases should be high in the list of differential diagnosis. Though there are several imaging methods to detect metastases, MRI-WB-DWI is a welcome alternative to the established methods. Patients who undergo RP for prostate cancer should be counselled regarding the importance of follow-up of their PSA levels. J Med Cases. 2020;11(9):275-278 doi: https://doi.org/10.14740/jmc3545