Skull X-ray Research Articles

Morpheus in Saber Stroke in a 17-Year-Old Boy with Aesthetic Repercussions Seen in Dermatological Consultation at the Sominé Dolo Hospital in Mopti

Morpheas are characterized by cutaneous induration (sclerosis), evidence of fibrosis of the dermis and sometimes of the underlying tissues without recognized etiology. We report a case of linear Morpheus in saber cut with aesthetic repercussions. A 17-year-old Malian boy consulted for a hypochromic strip of the face and scalp that had been evolving for 8 months. The lesion began with a non-pruritic and slightly painful erythematous spot. On inspection, it was a slightly atrophic hypochromic band, 2 cm wide and 12 cm long extending from the head of the left eyebrow to the vertex. Palpation found cutaneous sclerosis along the entire length of the band. There was no Raynaud's phenomenon or sclerodactyly. The rest of the clinical examination was normal. A biopsy of the lesion with anatomopathological examination was performed and the diagnosis of morphea was retained. The biological assessment carried out did not show any inflammatory syndrome or antinuclear factors. The skull x-ray did not find any bone abnormality. Treatment with systemic corticosteroids (prednisone) at a rate of 1 mg/kg/day associated with methotrexate 20 mg/week was introduced. After 3 months of well-monitored treatment, the evolution was favourable, with stabilization of the skin band. Morpheas cause aesthetic or functional damage that is sometimes significant. Their management must take into account the quality of life of affected subjects whose life expectancy is considered normal with an assessment of the risk- benefit of potentially aggressive therapies.

Variability in the management of infants under 3 months with minor head injury in paediatric emergency departments

IntroductionIn the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making. ObjectivesTo analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments (PEDs) and the adherence of each hospital to the recommendations of the PECARN rule. Population and methodsWe conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020. ResultsOf 21 981 children with MHI, 366 (1.7%) were aged less than 3 months; 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1%; interhospital range, 0%–40.0%), skull X-rays in 162 (44.3 %; range, 0%–100%) and transfontanellar ultrasound scans in 22 (6.0%; range, 0%–24.0%). The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%–100%); 37.1% (36/97) classified as intermediate-risk (range, 0%–100%) and 57.4% (132/230) classified as low-risk (range, 0%–100%). ConclusionWe found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish PEDs, mainly due to an excessive use of skull X-rays.

Comparison of Steiner Cephalometric analysis of lateral skull X-ray images with CBCT in a group of students of the dental school of the University of Cuenca

The Steiner analysis from images obtained from cone beam computed tomography is one of the essential tools today for diagnosis in the area of orthodontics, within this aspect its high value for the study of points, angles and cephalometric planes allows the prediction of the possible treatment plan for each patient according to the specific characteristics resulting in each patient. Objective: To compare the results in Steiner cephalometric measurements obtained in 2D lateral skull radiographs and in 3D cephalograms generated from Cone Beam Computed Tomography (CBCT). Methodology: Type of comparative analytical study. A non-probabilistic sample was established by convenience consisting of 29 diagnostic studies divided into: 29 lateral skull X-rays and 29 standardized CBCT. Subsequent localization, tracing and measurement of skeletal and dental angles were performed according to Steiner's cephalometric analysis using Nemostudio 2022 software. The study and analysis was performed using the Intraclass Correlation Coefficient. Results: The mean difference between the skeletal angles SNA, SNB, ANB, SND and Occlusal Plane Angle showed that there is no significant discrepancy when performing a cephalometric analysis in three-dimensional images compared to two-dimensional images. Conclusion: There is a high degree of reliability and accuracy of cephalometric measurements for obtaining skeletal and dental angles in two-dimensional images obtained from a CBCT with respect to a lateral radiograph.

Radiation Doses in Diagnostic Radiology and Method for Dose Reduction

Objective: The current research study aims to calculate entrance surface air kerma for skull, chest, cervical spine, lumbar spine, and pelvic X-ray examinations in interior posterior and posterior interior positions and generate a method for chest dose reduction to decrease radiation risk. Materials and Methods: The indirect dose measurement was used in the current research. The X-ray tube output was measured using RAD-CHECK Plus ionization chamber and the indirect entrance surface air kerma was calculated via applying physical acquisition parameters such as a focus on skin distance, tube current times exposure time (mAs), and applied tube voltage (kV), and applying a mathematical model. Results: The main findings were obtained from comparing the radiation doses with the reference levels of International organizations such as the American College of Radiology and the International Atomic Energy Authority. The mean entrance skin dose for the skull (AP), skull (PA), skull (LAT), cervical spine (PA), cervical spine (LAT), lumbar spine (AP), lumbar spine (LAT), pelvis (AP), and pelvis (LAT) of adult X-ray examinations was within the diagnostic reference dose level values obtained by ACR (2018) except for the ESD for chest (AP) which was 0.88 mGy. Conclusions: The results of the study concluded that by adjusting the applied tube voltage, kV, and tube current product time, mAs decreased the radiation dose to the chest X-ray by 58%.

Increasing Source-Object Distance: A Computed Radiography-based Strategy to Reducing Radiation Dose in Occipital-Frontal Skull X-Ray

Introduction: Exploring potential optimization strategies and developing evident practices is critical. Previous studies show that radiation dose can be reduced by increasing the source-image distance (SID). Although most studies use digital radiography, many hospitals in underdeveloped countries still use computed radiography (CR). Therefore, research will investigate the relationship between SID and Entrance surface dose (ESD) using the CR. Methods: This study involved the measurement of radiation dose and image quality of a radiological procedure performed at a reference SID; 100cm and the tested SIDs; 110cm, 120cm, and 130cm, using constant technical factors (70kVp, 25mAs, grid). A LiF; Mg Ti thermoluminescence dosimeter (TLD-100) chip was placed in the center of the radiation field of the OF10° skull radiography examination to measure ESD. Image quality was assessed using the European Commission guidelines and graded using relative visual assessment analysis (VGA). Results: Significant ESD reduction from 21% and 45% when SID was increased from 100cm to 130cm (p <0.001), where SID was negatively correlated with ESD (r= - 0.98). The VGA scores showed no statistical difference in the image quality of the OF10° skull radiography examination for the tested and reference images (p=0.21). VGA scores for 120cm images showed the highest image quality among the SIDs tested with a dose reduction of 37%. Conclusion: ESD was statically reduced when SID was increased from 100cm to 130cm, while image quality was diagnostically acceptable. The study suggests that 120cm is the optimal SID when both dose and image quality are considered.

Variabilidad en la atención en urgencias al lactante menor de 3 meses con un traumatismo craneoencefálico leve

IntroductionIn the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making. ObjectivesTo analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments and the adherence of each hospital to the recommendations of the PECARN rule. Population and methodsWe conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020. ResultsOf 21,981 children with MHI, 366 (1.7%) were aged less than 3 months; 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1%; interhospital range, 0%–40.0%), skull X-rays in 162 (44.3%; range, 0%–100%) and transfontanellar ultrasound scans in 22 (6.0%; range, 0%–24.0%). The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%–100%); 37.1% (36/97) classified as intermediate-risk (range, 0%–100%) and 57.4% (132/230) classified as low-risk (range, 0%–100%). ConclusionWe found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish paediatric emergency departments s, mainly due to an excessive use of skull X-rays.

A case of multiple myeloma with unusual presentation

Extramedullary plasmacytoma is a rare and unusual complication of multiple myeloma (MM). Some sites for the extramedullary involvement of MM are the liver, spleen, lymph node, lung, and skin. Renal failure is another complication of MM due to myeloma kidney, uric acid nephropathy, hemoconcentration, or light chain disease. This study reported a case of MM with unusual presentation. She was a 61-year-old woman who was admitted to the internal ward due to severe renal failure, anemia, mild proteinuria, hypertension, thrombocytopenia, and soft tissue mass in both lungs in the spiral computed tomography (CT) scan. In the skull X-ray, there was not any lytic lesion. Further, plasma cells greater than 30% were observed in serum protein electrophoresis pick of gamma region and in the bone marrow aspiration, so the final diagnosis of the patients was MM with extramedullary plasmacytoma.

PSAT197 Treatment of Paget's Disease of the Skull With Denosumab: A Case Report

Abstract Background Paget's disease of bone (PDB) is a common skeletal disorder characterized by increased osteoclastic activity and bone resorption followed by increased osteoblastic bone formation leading to an abnormality in modeling and remodeling of bone. Bisphosphonates are the most common treatments for PDB, with zoledronic acid being the most effective medication, but treatment would be difficult if bisphosphonates are contraindicated. Clinical case: We report a case of PDB of the skull in a 75-year-old woman presenting with a persistent headache that was successfully treated with denosumab. The patient had been complaining of severe headaches since December 2020. Her skull x-ray and laboratory results [calcium 8.2 mg/dL (range: 8.5-10.5 mg/dL), albumin 4 g/dL (range: 3.4- 4.8 g/dL), alkaline phosphatase 132 U/L (range: 35-104 U/L)] were consistent with PDB. Brain MRI and bone scintigraphy also showed skull changes consistent with PDB. Importantly, a DXA scan from July 2020 showed osteopenia, and her primary care provider treated it with denosumab in the first week of December 2020. At the time of PDB diagnosis in January 2021, zoledronic acid could not be administered because of mild hypocalcemia that was corrected with calcium carbonate. However, the headaches resolved, alkaline phosphatase normalized, and zoledronic acid was put on hold. Up until January 2022, she remains asymptomatic and alkaline phosphatase remains normal. Conclusion This case illustrates the successful management of PDB of the skull with denosumab, a human monoclonal antibody against RANKL. To the best of our knowledge, there have not been reported cases of full recovery of PBD with denosumab. Although PBD pathophysiology remains poorly understood, this case suggests that increased RANKL activity might mediate PBD directly or indirectly. Thereby, denosumab might be an effective treatment for some cases of PDB. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

LANGERHANS CELL HISTIOCYTOSIS IN A CHILD WITH ALBINISM AND INVASIVE SKULL LESIONS

<h3>Introduction</h3> Langerhans cell histiocytosis (LCH) is a rare disorder that involves excess production of dendritic cells, a form of histiocyte. LCH is heterogeneous in its presentation, varying from single bone lesions to multi-organ failure and considerable mortality. Here, we present a child with LCH who has albinism and persistent skull and orbital lesions. <h3>Case Description</h3> Patient from rural Guatemala was seen at the National Public Hospital of Escuintla during a medical mission trip. He was a 2-year-old boy with congenital albinism and a 6-month history of ulcerative lesions of the right periorbital, frontal, and retroauricular areas with purulent and malodorous discharge (Figure 1A,B). Lesions continued to worsen despite two courses of unknown oral antibiotics and chlorine dioxide rinses. Birth history was unremarkable; he received routine vaccinations including BCG. Skull x-ray showed a large area of decreased lucency in the right frontal and parietal lobe (Figure 1C). MRI of brain and orbits revealed a necrotic mass in the same area (Figure 1D). Wound cultures grew <i>Pseudomonas aeruginosa</i> and intravenous cefepime was initiated. Patient was transferred to the main cancer institute in Guatemala where biopsy of the skull lesion confirmed LCH. <h3>Discussion</h3> The diagnosis of LCH in our case was delayed primarily due to the limited resources and access to medical care. LCH can be invasive, and patients often need a multidisciplinary team approach in a tertiary care center. Additional immunologic studies and genetic evaluation, if available, can provide further insights. To our knowledge, this is the first report of LCH in a patient with albinism.

Craniofacial findings in acromegaly

A 40 years old female presented in the neurosurgery outpatient department with the complaint of broadening of face, increase in the size of hands and feet for past 10 years, and headache with decreased vision in both eyes for the last 1 year. MRI brain with pituitary protocol showed pituitary macroadenoma. Serum growth hormone (GH) and insulin-like growth factor-1 (IGF-1) were raised. X-ray skull lateral view showed prognathism (protrusion of lower jaw) with malocclusion of teeth (misalignment of biting surfaces of the upper and lower teeth) and an increased gap between teeth.

SELLA TURCICA BRIDGING IN PATIENTS WITH GORLIN-GOLTZ SYNDROME AND ITS IMPLICATIONS

Patients with Gorlin-Goltz syndrome, also called nevoid basal cell carcinoma syndrome (NBCCS), can present sella turcica bridging (STB), which has been associated with the development of dental and cervical vertebral anomalies. In our clinical cases series, we analyzed skull and cervical spine x-rays of 7 patients with NBCCS and STB. Three patients had STB associated with dental (agenesis, tooth impaction, hyperdontia, diastemata, microdontia, gyroversion, and supernumerary teeth) and cervical (rudimentary cervical discs and ossification of the nuchal ligament) anomalies, 3 had STB associated with dental alterations (tooth impaction, gyroversion, and agenesis), and 1 had STB associated with cervical abnormality (partial fusion of the vertebrae). The pathogenic mutation of genes (PTCH1, PTHC2, or SUFU) involved in the main pathway related to embryonic development, sonic hedgehog, promotes accumulate changes in the neural crest cells of patients with NBCCS, which phenotypically express as STB and dental and cervical vertebrae anomalies.

Assessment of patient radiation dose during skull X-ray examinations in King Khalid Hospital in Majmaah

This study aimed to measure entrance surface air kerma (ESAK, in mGy) during routine skull X-ray examinations of adult patients and to establish a local diagnostic reference level (LDRL) in the diagnostic radiology department of King Khalid Hospital in Majmaah. The patient's ESAK, mGy and effective dose (ED, in mSv) at the 75th percentile were calculated based on the output of the X-ray tube and the exposure parameters, as well as the use of suitable conversion coefficients, respectively. To calculate the ED and patient's ESAK, the output and exposure characteristics of the X-ray tube and relevant conversion coefficients were considered (ESAK). Additionally, the 75th percentile distributions for the ESAK and KAP distributions were calculated. A wide range of ESAK was observed, which might be due to the difference in the exposure factors applied for each examination. The mean values of ESAK and KAP together with 75th percentiles for Anteroposterior (AP) and lateral skull projection were 0.22 (0.10–0.30) mGy, 0.24 (0.0.18–0.25) mGy and 0.21 (0.19–0.26) Gy.cm2, 0.29 (0.17–0.32) Gy.cm2, respectively. The findings were significantly lower than national reference levels, the most reported European DRL values, and other previously reported dose values. The measured ESAK and KAP were within the recommended and acceptable dose limits. The best radiation protection can be achieved by optimizing the radiation dose while preserving image quality.

Surface Cranial Ultrasound: The Natural Heir to X-Ray for the Screening of Skull Deformities in Infants.

Volumetric tomography (3D-CT) is currently considered the gold standard for the diagnosis of craniosynostosis, but its use as the first-line examination for cranial deformities is a topic of debate, because of skull X-ray radiation and low sensitivity and specificity. Cranial ultrasound is an emerging noninvasive radiation-free alternative, but its diagnostic accuracy still needs confirmation. The present prospective study included 350 infants with skull deformities, who underwent cranial ultrasound as the first-line examination, followed by 3D-CT if the echography results was positive or unclear. If the results were negative, infants underwent physical treatment and follow-up. To evaluate ultrasound reliability, we focused on cases that underwent both the index test and the gold standard and performed a double-blind comparison of the echography and 3D-CT results. Ultrasound documented patent sutures in 293 infants and 9 had inconclusive results. The 293 ultrasound-negative infants were followed clinically: all improved, except 28 that underwent 3D-CT. In all of these cases, 3D-CT confirmed the ultrasonography results (no false negatives). 48 infants showed premature suture closure and underwent 3D-CT: 47 were confirmed (true positive), 1 was false positive. The sensitivity was 100%, the specificity was 99.7%, the positive and negative predictive values were 97.9% and 100%, respectively, the accuracy was 99.7%, and the diagnostic test evaluation was conclusive. The study documented the high sensitivity and specificity of echography for the diagnosis of craniosynostosis in a referral center, with better results being achieved before 6 months of age. Major limitations are the loss of diagnostic significance as the child grows and the learning curve needed. The advantages are avoidance of radiation and chance to evaluate the brain at the same time.

Estimation of Radiation Dose from Most Common Pediatrics Radiographic Examinations within Main Central Hospitals in Najaf City, Iraq

In this study the Entrance Surface Dose (ESD) received by pediatrics patients undergoing chest, abdomen and skull X-ray examinations was estimated. The study was conducted in two hospitals in Najaf city where three radiographic systems were considered. The study participants were classified into four age groups 0-1 , 1-5 , 5-10 and 10-15 years. Calculations were performed using exposure factors, kVp, mAs and focal-skin distance, together with patient data age. The ESD was calculated for the involved patients who underwent an Antero-posterior (AP) chest, abdomen and skull X-ray examination. The resulted data were analyzed and compared with international dose references. For all studied radiographic examinations and all X-ray machines, the ESD increases with age. The lowest recorded radiation dose was from hospital 1 machine 2. In this facility ESD ranged from 19.93 µGy to 67.66 µGy for chest X-ray, from 39.03 µGy to 82.63 µGy for abdomen (AP), and from 35.47 µGy to 94.27 µGy for skull (AP). In contrast the highest dose levels are recorded from hospital 2 machine 1; the minimum ESD for chest X-ray is 247.51 µGy and the maximum is 2393.12 µGy; for abdomen X-ray the lowest ESD is 269.05 µGy and the highest value is 5106.15 µGy; and for skull X-ray minimum values is 430.96 µGy and the maximum value is 3072.77 µGy. In conclusion, for the considered pediatrics examinations, most of ESD values are within the international acceptable level and some are higher &gt;100% .

Surviving Fifty Years With Shrapnel Within the Brain

AimsTraumatic brain injury during the war by shrapnel or bullet is lethal and life-threatening. The mortality rate from traumatic brain injury is more than 90%. Mrs. N (70) of Bangladesh is an exceptional and one of the luckiest women of the world. She is a war victim and has been living with shrapnel within her brain for the last 50 years.MethodsAccording to the patient attendant, half a century ago, during the Liberation War of Bangladesh, one shell accidentally exploded in their backyard. Unfortunately, a few pieces of shrapnel penetrated her arm, leg and right side of the head. She lost her consciousness and immediately treated at war hospital as per level best. She forgets details of her treatment and has no treatment records. Last 50 years, she has been surviving with movement difficulties, weaknesses of the upper and lower limbs and occasional convulsions. Her sufferings have intensified day by day. Last few years she has been experiencing headaches, dizziness, vomiting and forgetfulness. Two months back, she drank some insecticide mistakenly. She also suffering insomnia and she often cried out from deep sleep. She complains about hearing unknown voices. The voices were talking about her. She also started to suspect her family members. She claims that her family members were conspiring to kill her. She has history of convulsions three times in the last 50 years, which were generalized and tonic clonic in nature. She didn't take any medication for convulsion. As her suspicion, irrelevant talk and oddity in behavior worsened, her family members took her to me for treatment. Considering her past traumatic brain injury, an X-ray skull was advised. Surprisingly, it showed a metallic foreign body (shrapnel) within her skull. Furthermore, a CT scan of the brain was done, and it showed there was an irregular bony gap at right parietal area, a shrapnel at right frontal area with extensive encephalomalacic Porencephaly communicating with lateral ventricle. Her thyroid and liver function are normal. She is non-diabetic, non-hypertensive. She was advised to take risperidone 2 mg daily at night. With this low dose antipsychotic medication her psychosis controlled.ResultsSurviving with shrapnel within the brain followed by traumatic brain injury is very much rare. Shrapnel gradually damages the brain parenchyma and creates a large porencephaly.ConclusionTraumatic brain injury by bullet or shrapnel is always fatal. It is very much rare in medical to survive fifty years with shrapnel within the brain after shrapnel injury.

An unusual nasopharyngeal foreign body with unusual presentation

Upper aerodigestive tract may harbour foreign bodies such as sponges, grains, toy parts, stones, paper, insects, cotton,glass ball etc. These objects may go undetected for days or even weeks. A metallic foreign body after being inhaled and ultimately being lodged in the nasopharynx is a rare entity. We report a case of an unusual nasopharyngeal foreign body (glass ball) presenting with symptoms of nasal regurgitation and change in voice in a 2-year boy. The foreign body was diagnosed by X-ray skull lateral view including nasopharynx and was removed under general anaesthesia.

Cephalometric Landmark Detection in Lateral Skull X-ray Images by Using Improved SpatialConfiguration-Net

Accurate automated localization of cephalometric landmarks in skull X-ray images is the basis for planning orthodontic treatments, predicting skull growth, or diagnosing face discrepancies. Such diagnoses require as many landmarks as possible to be detected on cephalograms. Today’s best methods are adapted to detect just 19 landmarks accurately in images varying not too much. This paper describes the development of the SCN-EXT convolutional neural network (CNN), which is designed to localize 72 landmarks in strongly varying images. The proposed method is based on the SpatialConfiguration-Net network, which is upgraded by adding replications of the simpler local appearance and spatial configuration components. The CNN capacity can be increased without increasing the number of free parameters simultaneously by such modification of an architecture. The successfulness of our approach was confirmed experimentally on two datasets. The SCN-EXT method was, with respect to its effectiveness, around 4% behind the state-of-the-art on the small ISBI database with 250 testing images and 19 cephalometric landmarks. On the other hand, our method surpassed the state-of-the-art on the demanding AUDAX database with 4695 highly variable testing images and 72 landmarks statistically significantly by around 3%. Increasing the CNN capacity as proposed is especially important for a small learning set and limited computer resources. Our algorithm is already utilized in orthodontic clinical practice.

ANALYSIS OF OBTAINING AN IMAGE WITH THE TOMOGRAPH

CT scans vary from manufacturer to manufacturer. There are several generations of CT. The concept of CT generation is not so much related to the time of its birth, but to the use in the scanner of the type of motion of the emitter-detector system. The generation number (first, second, third, fourth, etc.) is related to the type of tube-detector system design. Three types of scanners are now available: third, fourth and fifth generation. The life of the first generation of CT was fleeting: the duration of the scan did not suit – about 20 minutes. and the computer reconstruction of the image took too long. Only the brain could be examined on such devices. As for the human body, the image turned out blurry, blurred. But the process of improvement continues. Today, research is being conducted on fourth- and fifth-generation devices. They have not one, but many X-ray emitters, up to 200. It uses a very powerful processor with high-speed information processing – up to 10 million operations per second. As a result, the scan time was reduced to 40-50 milliseconds. It is now possible (here is a scientific idea!) To see on the telemonitor the reduction of certain transverse layers of the heart 1-2 millimeters thick. At spiral CT in the course of research with simultaneous constant rotation of system “tube – detectors” the table constantly moves and thus there is a spiral movement of a fan-shaped beam through a patient’s body. Spiral CT makes it possible to examine the anatomical region in one period of respiratory arrest, and the thickness of the reconstructed layer is not related to the original width of the tomogram. Obtaining thin conjunctival sections, which are tightly arranged in a spiral, allows you to get three-dimensional reconstructions. In combination with intravenous bolus contrast and subtraction data processing, CT angiograms can be obtained, which reproduce images of large vessels. In recent years, multispiral (multislice) CT has been used, which is based on the principles of imaging as in spiral CT, but due to multi-row detectors for full rotation of the system “tube detectors” can display more than one slice (currently from 2 to 16 images). This has made it possible to perform studies of the heart, study a large anatomical area, such as the lungs, thin sections in one breath hold, and significantly improve the quality of multiplanar and three-dimensional reconstructions. In electron beam tomography, the source of X-rays is a large electron gun with several massive parallel anode targets located in semiconductor rings around the patient. The intense anode beam is directed along the tungsten anode rings. The electron beam thus obtained passes through the patient’s body and is received by a fixed array of detectors. This achieves a high tomography rate, which is sufficient for the study of a moving heart: clearly delineated images can be obtained without the use of synchronization with the ECG. With the help of electron-beam tomography it is also possible to perform CT angiography and construction of high-quality three-dimensional reconstructions. Thus, modern medicine is impossible without CT. For example, in neurology, computed tomography, in addition to skull bones, well identifies the ventricles of the brain, venous sinuses, subarachnoid cisterns, interhemispheric fissure, cortex, basal nodes, inner capsule, trunk, cerebellum and other structures. The radiation load does not exceed the level usual for X-ray examination. At the same time, CT scans provide 100 times more information about the brain than conventional skull x-rays. But its importance is not limited to use only for the diagnosis of various diseases. Under the control of CT perform punctures and directed biopsy of various organs and pathological foci. The role of CT in the control of conservative and surgical treatment of patients is extremely important. CT is a valuable method of accurate localization of tumors and directing the radiation source to the focus when planning radiation treatment of malignant tumors.

Skull fractures among head injured patients attending accident and emergency Hospital (Teaching) in Duhok City, Iraq

Objectives: To study the frequency of pattern, types and anatomical location of SF, in relation to the mechanism of injury, occupation and other important social and demographic variables. Also, to assess the outcome of SF within one year.&#x0D; Methods: A prospective, cross-sectional study on cases having SF attending Accident and Emergency Hospital (Teaching) (AEH) in Duhok City. This study has involved patients having a fresh SF; they were clinically evaluated, stabilized and thereafter subjected to plain skull X-ray (PSXR) and spiral computed tomography (CT) scan examination; no contrast was given; only few of them had magnetic resonance imaging (MRI) study.&#x0D; Results: There were 88 (62.7 %) males and 52 (37.3 %) females. Age ranged from 4 months 70 years, mean 10 years ± 13.5 standard deviation. Patients coming from urban regions formed 85 (60.7%), those from rural areas constituted 55 (39.3%).The most common causes were fall from height (FFH) 98 (70%), followed by road traffic accidents (RTA) 25 (17.9%), assault 4 (2.86%), ceiling fan injury 4 (2.86%), fall of heavy object on the head 3 (2.14%), penetrating injuries by missiles 4 (2.86%) and 2 (1.43 %) injured by unusual material (trauma by a thrown rock 1), and by sharp rotating machine –Kosara. The Glasgow Coma Scale (GCS) score was as follow: 13-15 in 110 (78.6 %), 9-12 in 19 (13.6%) and 3-8 in 11(7.9%) patients.&#x0D; Conclusions: Patients sustaining HI are mainly young age groups; males are more involved than females. The main causes were FFH, RTA, and assault. The majority of SFs are single, simple, and linear in their patterns.

Application of Deep Learning Techniques for Automated Diagnosis of Non-Syndromic Craniosynostosis Using Skull.

Non-syndromic craniosynostosis (NSCS) is a disease, in which a single cranial bone suture is prematurely fused. The early intervention of the disease is associated with a favorable outcome at a later age, so appropriate screening of NSCS is essential for its clinical management. The present study aims to develop a classification and detection system of NSCS using skull X-ray images and a convolutional neural network (CNN) deep learning framework. A total of 56 NSCS cases (scaphocephaly [ n = 17], trigonocephaly [n = 28], anterior plagiocephaly [n = 8], and posterior plagiocephaly [n = 3]) and 25 healthy control infants were included in the study. All the cases underwent skull X-rays and computed tomography scan for diagnosis in our institution. The lateral views obtained from the patients were retrospectively examined using a CNN framework. Our CNN model classified the 4 NSCS types and control with high accuracy (100%). All the cases were correctly classified. The proposed CNN model may offer a safe and high-sensitivity screening of NSCS and facilitate early diagnosis of the disease and better neurocognitive outcome for patients.