Spine AP Research Articles

Evaluation of radiation dose to Korean population by general radiography

General radiography has the highest usage among diagnostic radiology in Korea, resulting in high radiation dose by general radiography. For the medical radiation safety of patients, it is necessary to evaluate Korean population dose by general radiography. In this study, collective dose and per capita effective dose from general radiography in the Korean population were calculated. To this end, the raw data on the usage of general radiography in Korea as of 2017 was analyzed. Moreover, information on radiation dose from domestic general radiography was collected and PCXMC was used to evaluate the effective dose for patients during general radiography. As of 2017, the usage rate for lower extremity and chest examinations was high, accounting for more than 20 % of the total general radiography examinations. The effective dose depending on the examination type was the highest for whole-spine AP (1.06 mSv), followed by whole-spine LAT (0.61 mSv), and lumbar spine AP (0.51 mSv). As a result of evaluating Korean population dose by general radiography, the collective dose was 22,066 man∙Sv and the per capita effective dose was 0.43 mSv. The evaluation results of the Korea population dose obtained from this study can contribute to patient dose management in general radiography.

Hospital-based study of cervical rib/ribs and its association with neurological complication

Introduction: Cervical rib is an additional rib which is the costal element of seventh cervical vertebra. Hence cervical ribs may first be revealed by nervous (particularly on eighth cervical and first thoracic spinal nerve) and vascular symptoms. Cervical rib is more often unilateral and somewhat more frequent on the right. In 90% of cases cervical rib probably causes no trouble. So the present study addresses the prevalence of cervical rib/ribs among both adult male and female and Radiological measurement of costal elements and its association with neurological involvements. Aim: the main aim of this study is to find out the prevalence and relation of length of costal process of 7th cervical rib with neurological symptoms among KPC Medical College outdoor patients. Methods: A prospective study has been carried out using technically adequate cervical spine AP and chest x rays PA view taken in department of Radiology, KPC Medical College and Hospital. Results: In this study all numerical and nonnumeric data of 495 patients has been plotted in Excel of Office 13. Observed 13 cases of cervical rib/ribs in which 7 were unilateral and 6 bilateral. Out of these 13 cases 12 cases had rudimentary cervical ribs.

Trabecular bone score (TBS) in Cushing's disease: TBS gain after hypercortisolism normalization

ContextHypercortisolism frequently induces trabecular bone loss, more pronounced at the lumbar spine, resulting in osteoporosis, and thus an increase in fracture risk. Several studies have shown bone mass recovery in patients with Cushing's disease (CD) after treatment. ObjectiveTo examine treatment effects on TBS (trabecular bone score) in addition to aBMD (areal bone mineral density) in a cohort of patients with CD. Design and settingSingle-center retrospective longitudinal study in patients diagnosed with CD and successfully treated following surgery and/or medical treatment. PatientsWe included 31 patients with median age and BMI (body mass index) of 37.7 [28.4;43.3] years old and 27.7 [25.8;30.4] kg/m2, respectively. Median 24 h urinary cortisol before treatment was 213.4 [168.5;478.5] μg/24 h. All subjects were completely biochemically controlled or cured after treatment. Main outcome measuresaBMD and TBS were evaluated at AP Spine (L1-L4) with DXA prodigy (GE-Lunar), QDR 4500 (Hologic), and TBS iNsight® (Med-Imaps) before and after treatment. ResultsAbsolute TBS and aBMD gains following cure of CD were significant (p < 0.0001, and p < 0.001, respectively). aBMD and TBS increased by +3.9 and 8.2 % respectively after cure of CD. aBMD and TBS were not correlated before (p = 0.43) and after treatment (p = 0.53). Linear regression analyses showed that TBS gain was independent of baseline BMI and that low TBS at baseline was predictive of TBS gain after treatment. ConclusionThe more significant improvement of microarchitecture assessed by TBS than aBMD and the absence of correlation between TBS and aBMD suggest that TBS may be an adequate marker of bone restoration after cure of CD. To support this conclusion, future studies with larger sample sizes and longer follow-up periods should be carried out.

Entrance surface air kerma to patients during digital radiographic examinations in Tanzania.

The aim of this study was to determine the entrance surface air kerma (ESAK) in adult patients during digital radiography and to evaluate the optimisation potential in five common X-ray examinations in Tanzania. Based on a sample of 240-610 patients, ESAK was estimated using X-ray tube output measurements, patient information and backscatter factors. The results show that the mean ESAK values were higher or comparable to data from the literature. The diagnostic reference values of ESAK for digital radiography were 0.31 mGy (chest PA), 4 mGy (lumbar spine AP), 5.4 mGy (lumbar spine LAT), 3.8 mGy (abdomen AP) and 2.4 mGy (pelvis AP). For computed radiography, the mean ESAK ranges were 0.44-0.57 mGy (thoracic AP), 3.59-3.72 mGy (lumbar spine AP), 6.16-6.35 mGy (lumbar spine LAT), 3.89-3.44 mGy (abdominal AP) and 2.92-3.47 mGy (pelvic AP). In conclusion, high ESAK variations show the potential for optimising protection in digital radiology.

THU456 Beyond Guidelines: Treatment Of Concurrent Osteogenesis Imperfecta And Metastatic Bone Disease

Abstract Disclosure: M. Kanin: None. M. Lechner: None. Introduction: Osteogenesis imperfecta (OI) is a rare inherited skeletal dysplasia characterized by bone fragility and skeletal malformation predisposing patients to multiple, recurrent fractures. Treatment of OI is challenging and requires a multidisciplinary approach with emphasis on physical therapy and exercise in addition to medications. There is limited guidance on treatment in adults given truncated life expectancy. Furthermore, guidance on the treatment of OI in the setting of cancer bone metastases is lacking. We present the unique case of a woman with OI and new fracture in the setting of bone-metastatic endometrial cancer. Clinical Case: A 70 year old woman with Type I OI and endometrial adenocarcinoma initially presented to clinic with left hip and groin pain. Prior OI therapy included at least 10 years of bisphosphonate therapy and 3 years of intranasal calcitonin in her fifties. CT imaging revealed a lytic lesion in the L inferior pubic ramus with an associated pathologic fracture. She was treated with denosumab 120mg s.c. every 3 months for six total doses and palliative radiation to the pubic ramus. She developed osteonecrosis of the jaw and further treatment was terminated. She represented 2 years later with right hip pain and was found to have cancer involvement of her right iliac bone. Labs showed creatinine of 0.48 mg/dL, Calcium 9.8 mg/dl, bone specific alkaline phosphatase 17.9ug/L (7.0-22.4 ug/L), n-telopeptide 18.6 nM BCE (6.2-19.0 nM BCE), and vitamin D-25 48ng/ml. DEXA scan showed T scores at the AP spine of -3.2, LFN of -2.1, and RFN of -2.5. Our patient had a high functional status, minimal pain and acceptable quality of life. Given the presence of active bone metastases, we favored treatment with zolendronic acid 4mg i.v. monthly given her high fracture risk, combined with continued cancer therapy targeted to bone metastases. Clinical Lesson: To our knowledge, there are no guidelines or case reports for optimal treatment of patients with concurrent OI and bone metastases. While bisphosphonates are typically a first line treatment for OI, osteoporosis and metastatic bone disease, the duration and dosing of bisphosphonates varies for each condition. For example, zolendronic acid 4mg i.v. monthly is recommended for cancer patients with metastatic bone disease, while a dose of 5mg i.v. yearly is used for osteoporosis, depending on the severity. Additionally, no clear consensus exists for how often or how long bisphosphonates may be given in adults with OI and treatment durations vary markedly. Other agents that may be considered include denosumab, with indications across bone metastases, osteoporosis, and OI, though this was not available to our patient given her prior complication. Data for newer agents PTH analogs and romosuzumab are lacking. We present this case to highlight the need for an individualized treatment approach in these patients. Presentation: Thursday, June 15, 2023

FRI676 Undiagnosed Celiac Disease: A Silent Offender Of Male Osteoporosis

Abstract Disclosure: I.E. Hernandez Castro: None. A.M. Ludeña De Freitas: None. M.S. Martinez Aguiar: None. G. Irizarry: None. Osteoporosis affects both genders, with higher incidence in women after menopause. In men, it's often overlooked, leading to significant morbidity and mortality, if not diagnosed and treated early. Hip fractures in men have higher mortality than in women.Celiac disease is an immune reaction to gluten, causing nutrient malabsorption and inflammation-mediated injury to the small intestine, in genetically predisposed patients. It can lead to severe osteoporosis, especially if the disease remains undiagnosed for a long time.A 64-year-old male patient who does not follow any regular medical care, was transported to the emergency department due to dizziness, blurry vision, and left arm numbness for one day evolution. Physical examination was unremarkable, no signs of tetany noted. Laboratories showed corrected calcium 4.4mg/dL, sodium 130 mEq/L, potassium 2.5 mmol/L, phosphorus 4.41. PTH intact level 465.3 pg/mL, and ionized calcium level 5.2 mg/dL, measured after supplementation. Further studies revealed 24 hours urine calcium, sodium, and creatinine 52mg/day, 107mmol/day, and 1118mg/day, respectively. DEXA scan reported low bone mineral density (BMD) at AP spine L1-L4 of 0.860 with T-score of -3.0, BMD at femur neck of 0.579 with T-score of -3.8, and BMD at femur total of 0.622 with T-score of -3.6. The latter findings indicated severe osteoporosis, a rare and unexpected finding in a male patient younger than 70 years of age. Tissue transglutaminase IgA was positive with value of 611 u/mL and serum IgA 242mg/dL. Pathology report from tissue of the duodenum reported small bowel mucosa with focal gastric foveolar metaplasia and acute duodenitis, negative for dysplasia or malignancy. Immunohistochemical study for Helicobacter Pylori was positive and biopsy findings taken from the stomach, antrum, and body revealed gastric mucosa with moderate chronic active inflammation without intestinal metaplasia. Patient was diagnosed with secondary hyperparathyroidism due to celiac disease, a well-known studied risk factor for osteoporosis. Celiac disease caused malabsorption of nutrients and electrolytes, including calcium, which is essential for bone health. A gluten-free diet and supplements of oral calcium and vitamin D were started. Antiresorptive medications for osteoporosis were not started at this moment due to hypocalcemia and vitamin D deficiency. This case highlights the importance of considering Celiac disease as an uncommon but important etiology of osteoporosis. This malabsorptive condition should always be included among the differential diagnosis in male patients presenting with unexplained electrolyte imbalance and secondary hyperparathyroidism. Approximately 20% of diagnosed osteoporosis cases are men, and early diagnosis and treatment are crucial in preventing associated morbidity and mortality, especially if complicated by a hip fracture. Presentation: Friday, June 16, 2023

Prevalence and risk factors of osteoporosis and osteopenia among residents in Hubei province, China.

The disease burden of osteoporosis is increasing, but there are few studies on the prevalence and risk factors in Hubei, China. This study aims to analyze the prevalence of osteoporosis using dual-energy X-ray absorptiometry (DXA) measurement and the risk factors of osteoporosis using epidemiological survey methods. To explore the prevalence of osteoporosis and osteopenia in Hubei province, and provide the epidemiological basis for policymakers, to reduce the prevalence of osteoporosis METHODS: Based on data derived from the epidemiological survey of osteoporosis in Hubei province in 2018, 1592 residents aged 40 and above from 32 neighborhood committees/villages in 4 districts/counties of Hubei province were selected by multistage stratified random sampling. The lumbar spine AP (L1-L4 and L2-L4), femoral neck, and total hip BMD were measured using DXA of the internationally recognized gold standard and assessed according to WHO diagnostic criteria, utilizing unconditional logistic regression to explore the risk factors of osteoporosis and osteopenia. The overall crude prevalence of osteoporosis was 12.19%, 3.69% for males, and 18.94% for females. Osteopenia was diagnosed in 56.6% of all participants, 44.96% in males, and 65.84% in females. Increasing age, females, and underweight were related to the high prevalence of osteoporosis and osteopenia, while people with higher levels of education, overweight, and obese had a low prevalence of osteoporosis and osteopenia. In women, the absence of chronic disease and moderate intake of dairy products probably be associated with the low prevalence of osteopenia. The prevalence of osteoporosis and osteopenia is high in Hubei, China. The risk of prevalence of osteoporosis and osteopenia was higher in females and people with higher age and low BMI. While high BMI, high education, the absence of chronic disease, and intaking dairy moderately were negatively correlated with the prevalence of osteopenia or osteoporosis. The government should support the prevention and treatment of osteoporosis.

Evaluation of patient radiation doses using DAP meter in diagnostic radiology procedures in Birjand, Iran

BackgroundThe concept of diagnostic reference level (DRL) is considered a regular method to optimize radiation protection in diagnostic imaging system. The objective of implementing a reference level for dose is to produce high-quality images by applying a minimum dose of radiation based on the As Low As Reasonably Achievable (ALARA) principle. Therefore, this study aimed to evaluate the status of radiation protection in diagnostic radiology wards of educational hospitals affiliated with Birjand University of Medical Sciences.MethodsThis study was performed during a period of 11-months in the radiology center of the teaching hospital of Birjand University of Medical Sciences. The studied population included 477 patients who were referred to as clinically indicated x-ray radiography. In order to calculate local DRLs, dose area product (DAP) was measured by a DAP-meter (KERMAX-plus SPD, model 120–131 HS) for 11 devices at educational hospitals affiliated with Birjand University of Medical Sciences. The local DRL values was calculated as 75% of the mean DAP distribution for a specific patient trial at each center.ResultsDAP for Chest PA examination was gained to be in the range from 0.12 Gy.cm2 to 0.42 Gy.cm2 with an average value of 0.23 Gy.cm2 which is above the value of the reference level (0.12 Gy.cm2) for Chest PA. For Chest lateral the observed DAP was found to be in the range from 0.18 Gy.cm2 to 1.48 Gy.cm2 with an average value of 0.65 Gy.cm2 and are therefore twice the reference value (0.3 Gy.cm2). The higher DRL values (average = 2.73) are for lumbar spine lateral radiography. It is observed that the DRL values of chest PA, abdomen AP and Lumbar spine AP are much lower with the earlier studies.ConclusionsThe DRLs helps in understanding the current practices in radiographic examinations. Comparison with other hospitals, the scope of dose optimization and ultimately patient dose reduction in hospitals affiliated with Birjand University of Medical Sciences needs further investigation.

Novel AI-Based Algorithm for the Automated Computation of Coronal Parameters in Adolescent Idiopathic Scoliosis Patients: A Validation Study on 100 Preoperative Full Spine X-Rays.

Retrospective, mono-centric cohort research study. The purpose of this study is to validate a novel artificial intelligence (AI)-based algorithm against human-generated ground truth for radiographic parameters of adolescent idiopathic scoliosis (AIS). An AI-algorithm was developed that is capable of detecting anatomical structures of interest (clavicles, cervical, thoracic, lumbar spine and sacrum) and calculate essential radiographic parameters in AP spine X-rays fully automatically. The evaluated parameters included T1-tilt, clavicle angle (CA), coronal balance (CB), lumbar modifier, and Cobb angles in the proximal thoracic (C-PT), thoracic, and thoracolumbar regions. Measurements from 2 experienced physicians on 100 preoperative AP full spine X-rays of AIS patients were used as ground truth and to evaluate inter-rater and intra-rater reliability. The agreement between human raters and AI was compared by means of single measure Intra-class Correlation Coefficients (ICC; absolute agreement; >.75 rated as excellent), mean error and additional statistical metrics. The comparison between human raters resulted in excellent ICC values for intra- (range: .97-1) and inter-rater (.85-.99) reliability. The algorithm was able to determine all parameters in 100% of images with excellent ICC values (.78-.98). Consistently with the human raters, ICC values were typically smallest for C-PT (eg, rater 1A vs AI: .78, mean error: 4.7°) and largest for CB (.96, -.5mm) as well as CA (.98, .2°). The AI-algorithm shows excellent reliability and agreement with human raters for coronal parameters in preoperative full spine images. The reliability and speed offered by the AI-algorithm could contribute to the efficient analysis of large datasets (eg, registry studies) and measurements in clinical practice.

Typical effective dose values from diagnostic and interventional radiology

Effective dose (E) in medical procedures is of practical value for comparing doses from different types of procedures which is not possible with the different measurable dose quantities. In this survey we estimated and compared the values of E in 12 medical imaging procedures. The mean E for conventional X-ray in mSv were ranged between 0.01 for skull lateral to 0.5 for abdominal while the mean E for cardiac interventional radiology in mSv was up to 16 for percutaneous transluminal coronary angioplasty (PTCA). For dental radiology the mean E in μSv was 1.2 for intraoral and 10 for panoramic. In mammography the mean E was 0.5 mSv. Compared with the literature, chest postero–anterior (PA), lumbar spine AP, PTCA and mammography procedures had shown larger E values. The obtained results can help in justification of techniques.

ODP113 Presentation of two similar Klinefelter Syndrome cases with different clinical outcomes

Abstract Case 1 74-year-old Caucasian male with dysphagia, s/p laryngeal carcinoma, partial laryngectomy and past radiotherapy, was referred for breast enlargement with some increase over the last few years. He denied tenderness or breast discharge, but reported bilateral testicular atrophy, which he attributed to agent orange red exposure. Although married for 53 years, he did not have biological children. He had decreased libido, and denied testicular trauma, urinary symptoms, or history of infections, opiate, steroids abuse, or OTC herbal supplements. Pituitary MRI for head injury was normal. Physical exam-HT= 180.3 cm; 172 cm arm span, bilateral testicular atrophy. Laboratory findings: [PO4= 3.2mg/dL (2.5-4.9); Calcium=9.2 mg/dl(8.5-10.1);Magnesium =2.1 mg/dl(1.7-2.4); Vit D,25 OH=52.9 ng/mL (30–100); PTH =54.9 pg/ml (18.4-80.1),;FSH =41.7 mIU/mL(0 .7-10.8); LH=27.5 mIU/mL (1.2-10.6);Prolactin=4.5 ng/mL(2.5 -7.4); total Testosterone 81 ng/dL (250–1100); free testosterone 4.5pg/mL (30. 0-135. 0); Sex HBG 63 nmol/L (10–57); Estradiol &amp;lt;11.80 pg/mL(&amp;lt;11-39.8); Tumor marker BHCG &amp;lt;2mIU/mL (&amp;lt;5 mIU/ml; Cortisol, am=15.5 ug/dl (5.3-22.5);PSA=.260 ng/mL (0. 0- 4. 0)]. Karyotype analysis=47, XXY [15]/46, XX[5]. With supernumerary X chromosome, consistent with KS. DXA= osteopenia in AP spine and severe osteoporosis in other areas: femur neck left T-Score of -3.1. Right femur neck T-Score=-3. 0, total left femur T-Score= -2.9, right total femur T-Score of -2.9, left forearm radius 33% T-Score=-2.8. Mammogram: mild bilateral gynecomastia, L&amp;gt;R, Testosterone supplementation and intravenous zoledronic acid therapy were started. Case 2 74-year-old Caucasian male referred for low energy, generalized weakness, decreased libido and gynecomastia, long thin arms/legs and "difficulty building muscle". He was taking OTC "testosterone enhancers" herbals only. He reported no biological children. Physical exam: height 187.3 cm, with sparse body hair, absent facial hair, gynecomastia, small testes. Laboratory: [total testosterone=40 ng/dl; free testosterone=5.2 pg/ml; SHBG=40 nmol/L;LH=16.1 mIU/ml; FSH=31.8 mIU/ml; Prolactin=4.3 ng/ml; BHCG &amp;lt;3 mIU/ml; Estradiol=33.60 pg/m] Karyotype: mosaic KS 47, XXY[16]/46,XY[4] with additional X chromosome in 16/20 metaphase cells. DXA =normal bone density. Clinical symptoms and testosterone levels improved after starting testosterone supplementation. Discussion Hypogonadism is an important cause of male osteoporosis. Testosterone is known to regulate male bone metabolism both indirectly by aromatization to estrogens and directly through the androgen receptor on osteoblasts, promoting periosteal bone formation during puberty and reducing bone resorption during adult life. Early onset testosterone deficiency, as in KS, is an important risk factor for osteoporosis, although it is seen in only 40% of patients. Aromatization of testosterone into estradiol from adiposity, may also contribute to normal BMD in some patients. Therefore, it is important to recognize that osteoporosis is not always present in all Klinefelter's patients, even without testosterone therapy and that various phenotypes may account for discrepant conditions, as in these cases. Presentation: No date and time listed

Effect of 24-Week, Late-Evening Ingestion of a Calcium-Fortified, Milk-Based Protein Matrix on Biomarkers of Bone Metabolism and Site-Specific Bone Mineral Density in Postmenopausal Women with Osteopenia.

Dietary calcium intake is a modifiable, lifestyle factor that can affect bone health and the risk of fracture. The diurnal rhythm of bone remodelling suggests nocturnal dietary intervention to be most effective. This study investigated the effect of daily, bed-time ingestion of a calcium-fortified, milk-derived protein matrix (MBPM) or control (CON), for 24 weeks, on serum biomarkers of bone resorption (C-terminal telopeptide of type I collagen, CTX) and formation (serum pro-collagen type 1 N-terminal propeptide, P1NP), and site-specific aerial bone mineral density (BMD), trabecular bone score (TBS), in postmenopausal women with osteopenia. The MBPM supplement increased mean daily energy, protein, and calcium intake, by 11, 30, and 107%, respectively. 24-week supplementation with MBPM decreased CTX by 23%, from 0.547 (0.107) to 0.416 (0.087) ng/mL (p < 0.001) and P1NP by 17%, from 60.6 (9.1) to 49.7 (7.2) μg/L (p < 0.001). Compared to CON, MBPM induced a significantly greater reduction in serum CTX (mean (CI95%); −9 (8.6) vs. −23 (8.5)%, p = 0.025 but not P1NP −19 (8.8) vs. −17 (5.2)%, p = 0.802). No significant change in TBS, AP spine or dual femur aerial BMD was observed for CON or MBPM. This study demonstrates the potential benefit of bed-time ingestion of a calcium-fortified, milk-based protein matrix on homeostatic bone remodelling but no resultant treatment effect on site-specific BMD in postmenopausal women with osteopenia.

Evaluation of Repeat Analysis and Dose Burdens of Patients Examined in the Radiology Department of a Medical University Teaching Hospital in Nigeria

The objectives of this study was to examine the repeated examinations carried out and dose burdens of patients examined in the radiology department of a tertiary institution teaching hospital in Nigeria. A standard daily record keeping method (accepted and rejected films compiled by Radiographers) was used to collect data after viewing by a Radiologist. Raw data collected were sorted with the aid of Tally Chart. Descriptive statistics was employed to analyze the data collected with the help of Excel software. The specific repeat rates (SRRs) for different examinations are as follows: chest PA (CXR-6.68 %); lumbosacral (LS-10.90%); skull/head (S/H-15.08 %); abdomen (ABD-12.97 %); pelvis/hip (PE/H-7.77 %); cervical spine/neck (SP/NK-5.56 %); thoracic spine (TS-7.14 %); extremities (EXT-1.64 %); shoulder joint (SHJ-2.22 %); knee joint (KNJ-2.99 %); elbow joint (ELB-2.53 %); ankle joint (ANK-2.77 %); and hysterosalpingography (HSG-7.35 %). The highest causal reject rates (CRRs) was found to be as a result of under-penetration (34.3%) in this study. This is followed in succession by over-collimation (22.90 %) and processing artifact (20.50 %). The excessive population doses of the exposed patients resulting from repeats for some examinations are: chest PA (CXR-103.60 mGy); lumbosacral AP (LS-23.00 mGy); skull/head PA (S/H-71.10 mGy); abdomen AP (ABD-33.48 mGy); thoracic spine AP (TS-2.52 mGy); shoulder joint AP (SHJ-1.89 mGy); knee joint AP (KNJ-2.00 mGy); ankle joint AP (ANK-0.76 mGy); hysterosalpingography (HSG-1.95 mGy). The selected exposure parameters could also be examined and adjusted to prevent under-penetration.

X-Ray Dose Audit and Potential Local Diagnostic Reference Levels in Select Hospitals In Kaduna State, Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Background: Dosimetry in diagnostic radiology is fundamental to providing information to practitioners regarding the level of their doses and to ensure adequate optimization of the protection of patients presenting for radiological examinations. The introduction and implementation of diagnostic reference levels (DRLs) in diagnostic radiology has proven to be a potent tool for quality control and dose reduction. This has not been comprehensively addressed in Nigeria.&#x0D; Objective: To carryout dose audit of patients presenting for common radiographic projections in select hospitals in Kaduna State, Nigeria.&#x0D; Methodology: Thermoluminescent dosimeters (TLDs) were used to measure entrance surface dose (ESD) on 420 randomly selected adult patients presenting for x-ray examination of the chest PA/Lateral, skull PA/Lateral, lumbar spine AP/Lateral, abdomen and pelvic AP, respectively. Results were compared with existing literature.&#x0D; Results: The range of the mean ESD determined for the study population on various x-ray examinations were: chest PA (0.44 – 0.9 mGy), and lateral (0.9 – 1.5 mGy); skull PA (2.0 – 4.7 mGy), and lateral (1.7 – 3.4 mGy); lumbar spine AP (3.4 -7.8 mGy), and lateral (6.8 –11.3 mGy); abdomen AP (3.6 – 6.2 mGy); and pelvic AP (2.4 – 6.9 mGy). Comparison showed dose levels were below IAEA recommendations.&#x0D; Conclusion: In the absence of arbitrary high doses, practice is generally safe and will not result in unwarranted hazards to the patients.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

X-Ray Dose Audit and Potential Local Diagnostic Reference Levels in Select Hospitals In Kaduna State, Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Background: Dosimetry in diagnostic radiology is fundamental to providing information to practitioners regarding the level of their doses and to ensure adequate optimization of the protection of patients presenting for radiological examinations. The introduction and implementation of diagnostic reference levels (DRLs) in diagnostic radiology has proven to be a potent tool for quality control and dose reduction. This has not been comprehensively addressed in Nigeria.&#x0D; Objective: To carryout dose audit of patients presenting for common radiographic projections in select hospitals in Kaduna State, Nigeria.&#x0D; Methodology: Thermoluminescent dosimeters (TLDs) were used to measure entrance surface dose (ESD) on 420 randomly selected adult patients presenting for x-ray examination of the chest PA/Lateral, skull PA/Lateral, lumbar spine AP/Lateral, abdomen and pelvic AP, respectively. Results were compared with existing literature.&#x0D; Results: The range of the mean ESD determined for the study population on various x-ray examinations were: chest PA (0.44 – 0.9 mGy), and lateral (0.9 – 1.5 mGy); skull PA (2.0 – 4.7 mGy), and lateral (1.7 – 3.4 mGy); lumbar spine AP (3.4 -7.8 mGy), and lateral (6.8 –11.3 mGy); abdomen AP (3.6 – 6.2 mGy); and pelvic AP (2.4 – 6.9 mGy). Comparison showed dose levels were below IAEA recommendations.&#x0D; Conclusion: In the absence of arbitrary high doses, practice is generally safe and will not result in unwarranted hazards to the patients.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Patient-Based Dose Audit for Common Radiographic Examinations With Digital Radiology Systems: A Retrospective Cross-Sectional Study.

This study aims to audit radiation doses of adult patients who underwent common diagnostic X-ray examinations and compare dose area product (DAP) values with the established International Diagnostic Reference Level (IDRLs). Retrospective cross-sectional records of 339-patients who underwent 699-radiographic examinations between October 2018 and March 2019 were obtained. Patient-related factors, exposure, and DAP data were recorded for the six most common examinations. The mean and 75th percentile of DAPs were recorded and compared to IDRLs values. The 75th percentiles of the locally measured DAPs were below IDRLs for all examinations except for lateral lumbar, AP, and lateral thoracic spine, in which DAP-75th-percentile exceeded all IDRLs by up to 40.7%, 2.8%, 365.5%, respectively. Considering the type of detector used, the mean of the locally measured DAPs significantly exceeded the UK DRLs for the lateral thoracic spine and lateral lumbar spine. Locally measured DAP values were below the IDRLs except for thoracic and lumbar spine projections, which significantly exceeded.

Optimal exposure factors for lumbar spine AP in computed radiography examinations

Optimal exposure factors for lumbar spine AP in computed radiography examinations

Optimal exposure factors for lumbar spine AP in computed radiography examinations

Optimal exposure factors for lumbar spine AP in computed radiography examinations

Optimal exposure factors for lumbar spine AP in computed radiography examinations

Background: In diagnostic radiography, selection of kVp and mAs to produce acceptable image quality with a minimum dose has been a challenge even for experience radiographers. The aim of this study was to determine optimal exposure factors for lumbar spine AP examinations in computed radiograph using dose-image quality analysis. Materials and Methods: A female anthropomorphic phantom was used for dose-image quality analysis to determine the optimal exposure factors (mAs and kVp) for lumbar spine AP. Indirect method was used to estimate the entrance skin dose (ESD) to the anthropomorphic phantom. kVp values of 70, 80, 90 and100 were selected while mAs values of 16, 18, 20,22,25, 28,32, 36, 40, 45 and 50 were also selected for the acquisition of all the images. Three (3) senior radiographers evaluated the image quality using image quality criteria set up by European Commission. Results: The result indicated that the image quality score increased as ESD (mGy) increased. However, there was no significant change in image quality score between ESD of 1.941 and 4.882 mGy. 70 kVp and 22 mAs were accepted as optimal exposure factors for standard body size lumbar spine AP examinations in diagnostic radiography of computed radiography (CR). Conclusion: Optimization of exposure factors (kVp and mAs) is necessary in radiographic examinations to ensure safe use of radiation in medicine. It ensures effective patient dose management because radiograph with high quality can be obtained for effective diagnostic information.

Classification of neurofibromatosis-related dystrophic or nondystrophic scoliosis based on image features using Bilateral CNN.

We developed a system that can automatically classify cases of scoliosis secondary to neurofibromatosis type 1 (NF1-S) using deep learning algorithms (DLAs) and improve the accuracy and effectiveness of classification, thereby assisting surgeons with the auxiliary diagnosis. Comprehensive experiments in NF1 classification were performed based on a dataset consisting 211 NF1-S (131 dystrophic and 80 nondystrophic NF1-S) patients. Additionally, 100 congenital scoliosis (CS), 100 adolescentidiopathicscoliosis (AIS) patients, and 114 normal controls were used for experiments in primary classification. For identification of NF1-S with nondystrophic or dystrophic curves, we devised a novel network (i.e., Bilateral convolutional neural network [CNN]) utilizing a bilinear-like operation to discover the similar interest features between whole spine AP and lateral x-ray images. The performance of Bilateral CNN was compared with spine surgeons, conventional DLAs (i.e., VGG-16, ResNet-50, and Bilinear CNN [BCNN]), recently proposed DLAs (i.e., ShuffleNet, MobileNet, and EfficientNet), and Two-path BCNN which was the extension of BCNN using AP and lateral x-ray images as inputs. In NF1 classification, our proposed Bilateral CNN with 80.36% accuracy outperformed the other seven DLAs ranging from 61.90% to 76.19% with fivefold cross-validation. It also outperformed the spine surgeons (with an average accuracy of 77.5% for the senior surgeons and 65.0% for the junior surgeons). Our method is highly generalizable due to the proposed methodology and data augmentation. Furthermore, the heatmaps extracted by Bilateral CNN showed curve pattern and morphology of ribs and vertebrae contributing most to the classification results. In primary classification, our proposed method with an accuracy of 87.92% also outperformed all the other methods with varied accuracies between 52.58% and 83.35% with fivefold cross-validation. The proposed Bilateral CNN can automatically capture representative features for classifying NF1-S utilizing AP and lateral x-ray images, leading to a relatively good performance. Moreover, the proposed method can identify other spine deformities for auxiliary diagnosis.