Standard Radiological Examination Research Articles

Cine-MRI and T1TSE Sequence for Mediastinal Mass.

Background/Objectives: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating the extent of mediastinal tumors. If tumor infiltration into the large central thoracic vessels, the pericardium, or the myocardium is suspected, cine magnetic resonance imaging (cine-MRI) can provide additional valuable information. Methods: We conducted a retrospective study of patients with mediastinal tumors who were staged with CT, cine-MRI, and a T1-weighted turbo spin echo (T1TSE) prior to surgical resection. Imaging was re-evaluated regarding tumor infiltration into the pericardium, myocardium, superior vena cava, aorta, pulmonary arteries, and atria and compared with intraoperative findings and postoperative histopathological reports (gold standard). Unclear CT findings were further investigated. Results: Forty-seven patients (29 female and 18 male patients; median age: 58 years) met the inclusion criteria. Cine-MRI was able to predict infiltration of the aorta in 86%, pulmonary arteries in 85%, and atria in 80% of unclear CT cases. Aortic tumor infiltration in unclear CT cases was significantly more often correctly diagnosed with cine-MRI than with T1TSE sequence. Conclusions: Additional cine-MRI is of crucial benefit in unclear CT cases. We recommend performing cine-MRI if infiltration into the large central vessels and atria is suspected. T1TSE sequence is of very limited additional value.

Lateral Approach for Distal Articular Fractures of Humerus in Canines-A Review of 4 Cases

Background: Humeral condylar fractures have fracture lines that extend through the joint surface and through one or both epicondyles or epicondylar crests, or into the distal shaft. Addressing the distal articular Humeral fractures in dogs through lateral approach by using positional transcondylar screws. Methods: A total of four cases of dogs with different age groups, breeds and sex with fore limb lameness caused due to trauma were included in the study. Clinical and standard radiological examination of all revealed intercondylar fractures with reduced range of motion where the fracture of the condyle extending from the articular surface. After preoperative evaluation all the animals were subjected to surgical reduction by lateral approach under general anaesthesia using positional transcondylar screws (n=2) with or without K-wires in cross fashion (n=2). This approach avoided the necessity of olecranon osteotomy and triceps tenotomy with their associated complications. Result: Excellent limb utility was obtained during postoperative period by clinical and radiographical grading system. To conclude, the use of fully threaded cortical screws was found effective for surgical management of distal humeral condylar fractures in dogs via lateral exposure.

A Score to Predict the Malignancy of a Breast Lesion Based on Different Contrast Enhancement Patterns in Contrast-Enhanced Spectral Mammography.

Simple SummaryContrast-enhanced spectral mammography (CESM) represents a novel, reliable imaging adjunct for the early detection and management of breast lesions by coupling high sensitivity and specificity. Early diagnosis of breast tumors using this innovative diagnostic method could help in reducing the high number of unnecessary biopsies for breast lesions considered as suspicious by standard radiological examination (such as mammography, ultrasound, and magnetic resonance). Considering its relative recent introduction, there are still no standardized methods for assessing the diagnostic performance of CESM enhancement descriptors. Here, we aim to create a score that takes account four CESM enhancement descriptors able to efficiently predict the malignancy of a breast lesion prior to biopsy.Background: To create a predictive score of malignancy of a breast lesion based on the main contrast enhancement features ascertained by contrast-enhanced spectral mammography (CESM). Methods: In this single-centre prospective study, patients with suspicious breast lesions (BIRADS > 3) were enrolled between January 2013 and February 2022. All participants underwent CESM prior to breast biopsy, and eventually surgery. A radiologist with 20 years’ experience in breast imaging evaluated the presence or absence of enhancement and the following enhancement descriptors: intensity, pattern, margin, and ground glass. A score of 0 or 1 was given for each descriptor, depending on whether the enhancement characteristic was predictive of benignity or malignancy (both in situ and invasive). Then, an overall enhancement score ranging from 0 to 4 was obtained. The histological results were considered the gold standard in the evaluation of the relationship between enhancement patterns and malignancy. Results: A total of 321 women (median age: 51 years; range: 22–83) with 377 suspicious breast lesions were evaluated. Two hundred forty-nine lesions (66%) have malignant histological results (217 invasive and 32 in situ). Considering an overall enhancement score ≥ 2 as predictive of malignancy, we obtain an overall sensitivity of 92.4%; specificity of 89.8%; positive predictive value of 94.7%; and negative predictive value of 85.8%. Conclusions: Our proposed predictive score on the enhancement descriptors of CESM to predict the malignancy of a breast lesion shows excellent results and can help in early breast cancer diagnosis and in avoiding unnecessary biopsies.

Лікування «нещасливої тріади» плечового суглоба

Актуальність. «Нещаслива тріада» плечового суглоба — це тяжка та доволі поширена травма (9–18 % серед усіх вивихів плеча). Під нею розуміють комбінацію вивиху плеча, масивного повношарового розриву ротаторної манжети та ушкодження аксилярного нерва або підключичних відділів плечового сплетення. Мета роботи: на основі аналізу результатів власних досліджень визначити оптимальну тактику обстеження та лікування хворих з «нещасливою тріадою» плечового суглоба. Матеріали та методи. У період з 2000 по 2016 рік у відділенні мікрохірургії та реконструктивної хірургії верхньої кінцівки ДУ «Інститут травматології та ортопедії НАМН України» було проліковано 120 пацієнтів з діагнозом травматичного вивиху плеча. Серед них у 25 (20,8 % від загальної кількості травматичних вивихів) пацієнтів була діагностована «нещаслива тріада» плеча. Усім пацієнтам проводились стандартне клінічне, рентгенологічне дослідження, електронейроміографія (ЕНМГ) та магнітно-резонансна томографія. Результати. Усі пацієнти з даною патологією потребують передопераційного ЕНМГ-дослідження, у випадку збереження провідності за аксилярним нервом більше 30 % на першому етапі лікування рекомендоване відновлення цілісності ротаторної манжети плеча з призначенням консервативного лікування нейропатії. У разі збереження провідності за аксилярним нервом менше 30 % першим етапом лікування варто проводити ревізію та відновлення цілісності аксилярного нерва. Обов’язкова фіксація плеча у вправленому положенні. Висновки. Аналізуючи віддалені результати лікування пацієнтів з «нещасливою тріадою» плечового суглоба, ми виявили залежність між тяжкістю травми та результатами лікування. Так, коли на передопераційній ЕНМГ визначались збереження провідності за аксилярним нервом та позитивна динаміка відновлення, результати лікування через 12 місяців були найкращі. Найгірші результати були у первісно найтяжчих пацієнтів — з підключичним ушко­дженням плечового сплетення.

The Potential Role of Airways Periostin in the Clinical Practice of Patients Affected by Idiopathic Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a chronic debilitating fibrotic lung disease leading to respiratory failure and ultimately to death. Noninvasive biomarkers, for the early diagnosis, differential diagnosis, prognosis, and prediction of therapeutic response, are needed. Previous studies support a role for periostin in lung fibrosis. The aim of our study was to analyze periostin levels in the airways of patients with IPF and to investigate its role as a useful predictive biomarker of the disease. We enrolled 30 IPF patients and 5 control subjects. All subjects underwent all standard radiological, functional, and biological examinations for IPF diagnosis and staging and exhaled breath condensate (EBC) collection. Periostin was assessed by an enzyme-linked immunosorbent assay kit on EBC. Periostin was dosable in the EBC of all subjects enrolled. We found higher exhaled periostin levels in IPF patients than healthy controls (65.5 ± 23.5 pg/mL vs. 33 ± 21.4 pg/mL, p < 0.05). Moreover, in receiver operating characteristic analysis, the clinical reference value of periostin was 37.88 pg/mL to discriminate patients with IPF from healthy subjects, with the area under the curve of 0.8815. There was no significant correlation between periostin levels and gender or pulmonary function tests. These preliminary results support our working hypothesis that periostin is dosable in the airways of patients with IPF. As the circulating periostin, also airways periostin may be a potential biomarker to support IPF diagnosis and to monitor disease progression during follow-up.

A novel p.A191D matrilin-3 variant in a Vietnamese family with multiple epiphyseal dysplasia: a case report

BackgroundMultiple epiphyseal dysplasia (MED) is a common skeletal dysplasia that is characterized by variable degrees of epiphyseal abnormality primarily involving the hip and knee joints. Mutations in a gene encoding matrilin-3 (MATN3) have been reported as disease causing of autosomal dominant MED. The current study identified a novel c.572 C > A variant (p.A191D) in exon 2 of MATN3 in a Vietnamese family with MED.Case presentationA standard clinical tests and radiological examination were performed in an 8-year-old Vietnamese girl patient. The clinical examination showed that patient height was under average, with bent lower limbs, limited mobility and dislocation of the joints at both knees. Radiological documentation revealed abnormal cartilage development at the epiphysis of the femur and patella. The patient has a varus deformity of the lower limbs. The patient was diagnosed with autosomal dominant MED using molecular testing in the order of the coding sequences and flanking sequences of five genes: COMP (exons 8–19), MATN3 (exon 2), COL9A2 (exon 3), COL9A3 (exon 3), COL9A1 (exon 8) by Sanger sequencing. A novel heterozygous missense variant (c.572 C > A, p.A191D) in MATN3 was identified in this family, which were not inherited from parents. The p.A191D was predicted and classified as a pathogenic variant. When the two predicted structures of the wild type and mutant matrilin-3 were compared, the p.A191D substitution caused conformational changes near the substitution site, resulting in deformity of the β-sheet of the single A domain of matrilin- 3.ConclusionsThis is the first Vietnamese MED family attributed to p.A191D matrilin-3 variant, and our clinical, radiological and molecular data suggest that the novel de novo missense variant in MATN3 contributed to MED.

Failure Analysis of Retrieved Osteosynthesis Implants.

Failure of osteosynthesis implants is an intricate matter with challenging management that calls for efficient investigation and prevention. Using implant retrieval analysis combined with standard radiological examination, we evaluated the main causes for osteosynthesis implant breakdown and the relations among them for a series of cases. Twenty-one patients diagnosed with implant failure were assessed for this work. For metallurgical analysis, microscopy techniques such as scanning electron microscopy (SEM), stereomicroscopy, and optical microscopy were employed. The results showed that material structural deficiencies (nine patients) and faulty surgical techniques (eight patients) were the main causes for failure. An important number of patients presented with material structural deficiencies superimposed on an imperfect osteosynthesis technique (six patients). Consequently, the importance of failure retrieval analysis should not be overlooked, and in combination with other investigational techniques, must provide information for both implant manufacturing and design improvement, as well as osteosynthesis technique optimization.

Obesity Influences the Knee Injury and Osteoarthritis Outcome Score.

Purpose The primary aim of this study was to report the outcome of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in obese patients with a body mass index (BMI) > 35. Methods This is a prospective cohort study, including patients referred with the aim of planning bariatric surgery between October 2015 and January 2017. The primary outcome measurement was KOOS. An experienced radiologist obtained and evaluated standard radiological osteoarthritis examinations of the knee joints. Results The mean age was 43.1 years, and ages ranged from 24 to 69 years. The mean BMI was 48.3, and BMI ranged from 35 to 66. Results show that obese patients reported significantly worse in the KOOS subscales pain, activities of daily living, sport, and quality of life (QOL) compared with a reference population, due to nonoverlapping 95% confidence intervals. No significant differences between obese and superobese patients were observed on the KOOS subscales ( p > 0.08). The KOOS subscales showed worse outcome with increasing severity of radiological knee osteoarthritis; however, only significant differences were observed for the KOOS subscales sport and QOL ( p < 0.05). Conclusion Results imply that the KOOS scores vary significantly with obesity. When utilizing KOOS outcome, considering obesity in the interpretation of outcome is highly recommended. Level of Evidence This is an observational, level III study.

The patellar pubic percussion test: a simple bedside tool for suspected occult hip fractures.

Patellar finger tapping produces a typical sound that can be detected by a stethoscope positioned on the pubic bone (patellar pubic percussion test (PPPT)). Characteristics of this sound are determined by continuity of bone between patella and pelvis. We hypothesized that a PPPT was able to detect overt hip fractures and occult hip fractures that may not be determined by a standard radiological examination. Two independent observers performed a PPPT in patients with a suspected hip or pelvic fracture, just before a conventional radiograph (X-ray) was performed. The PPPT test was scored as negative (similar to contralateral side) or positive (different). Patients with a positive PPPT but with a negative X-ray underwent an additional CT scan. One hundred and ninety-one patients with suspected hip or pelvic fracture were included. A total of 161 patients (84%) were diagnosed with a fracture (hip, n = 142; pelvic, n = 19). An 85% sensitivity, a 70% specificity, a 0.94 positive predictive value, and a 0.47 negative predictive value of the PTTT were calculated. The inter-observer reliability (kappa) was 0.7. Eleven CT scans as indicated by a mismatch between PPPT (positive) and X-ray (no fracture) identified eight fractures (73%). A multivariate analysis demonstrated that a painful passive movement and the PPPT predicted a hip fracture. The PPPT is a simple bedside diagnostic tool that is sensitive in detecting clinically straight forward hip fractures as well as occult hip fractures. The PPPT can support decision-making for additional radiological examinations in case of potential occult pelvis or hip fractures.

Reverse Shoulder Arthroplasty with a New Convertible Short Stem: Preliminary 2- to 4-year Follow-up Results

Background The Grammont-style reverse shoulder arthroplasty (RSA) has demonstrated complications intrinsic to its design such as tuberosity fracture and scapular notching. A new short-stem press-fit humeral component with an onlay tray has been devised to avert these issues. We hypothesize that the clinical outcomes and rates of humeral complications of this new stem will be comparable to those of the traditional Grammont design and the lateralization obtained from the stem’s lower neck-shaft angle will decrease the rate of notching without creating instability. Methods We retrospectively evaluated 100 patients who underwent RSA with an onlay short-stem humeral component with a minimum follow-up of 2 years. Clinical outcomes as well as standard radiological examinations were documented pre- and postoperatively. Several correlations were analyzed. Results At mean 32.6-month follow-up, the cohort demonstrated a significant improvement in several outcomes: Constant score increased from 25.5 to 69.7 points, mean anterior elevation increased from 82.1° to 141.9°, external rotation from 5.6° to 25.1°, and internal rotation from sacrum to the L3 vertebral level. There was a 30% rate of stem malalignment and 37% rate of scapular notching, not associated with any adverse clinical outcomes. The overall rate of complications was 15%, of which scapular fractures were most common (5%). Conclusion Our short-term results suggest that the clinical outcomes and rates of humeral complications are similar to those reported for the Grammont RSA, demonstrating less scapular notching, but increased scapular stress fractures and potential subsidence of the prosthesis due to the metaphyseal press-fit require further investigations.

Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest

ObjectiveThe purpose of the present study was to evaluate crestal bone level changes around dental implants after iliac bone augmentation in the long term. Material and methodsA total of 32 partially edentulous/edentulous patients (mean age, 52 years; range, 22–70 years) and a remaining bone volume of less than 5 mm of the alveolar ridge underwent maxillary or mandibular iliac bone graft augmentation. All patients received spaced standardized radiological examination for evaluation of peri-implant crestal bone loss. ResultsThe grafting procedure was successfully performed in all patients. A total of 150 implants were placed. The mean observation period was 69 months (range, 12–165 months; success rate for maxilla, 96%; success rate for mandible, 92%). The mean amount of crestal bone loss after 10 years was 1.8 mm. A significant difference between gender and crestal bone loss was shown, but no influence was found regarding the implant system, diameter of implant, and age of the patients. ConclusionIn patients with atrophic jaws, a sufficient long-term reconstruction can be achieved with the combination of iliac onlay grafting and dental implants. The results demonstrate high success rates and a stable peri-implant bone level in the long term.

Sepsis of the hip due to pressure sore in spinal cord injured patients: advocacy for a one-stage surgical procedure.

Retrospective study reporting characteristics and management of septic arthritis of the hip due to pressure sores in spinal cord-injured patients. To describe clinical and biological data of septic arthritis of the hip and its treating management. The database of the regional SCI referral center, Nantes, France. We retrospectively collected data from 33 cases of septic arthritis of the hip in the medical files of 26 patients. We analyzed 33 cases of septic arthritis of the hip treated in one French referent center for spinal cord-injured patients from January 1988 to December 2009. Most patients had a thoracic complete paraplegia and nearly two-third (17 out of 26) had no systematic follow-up. In 25 out of 33 cases, the septic arthritis of the hip was due to a trochanteric pressure sore. The causal pressure sore was most frequently associated with a persistent drainage. The standard radiological examination led to the diagnosis in 30 cases and, in 7 questionable cases, magnetic resonance imaging was more contributory. Surgery always consisted of a wide carcinological-like excision and of a subtrochanteric proximal femoral resection including both greater and lesser trochanters. A musculocutaneous flap was realized for all cases and the choice of the muscle depended on the localization of the causal pressure sore but also of the remaining choices, as most of the patients had already undergone a prior surgery. An antibiotic treatment was adapted to multiple samples during surgery. We do advocate for a one-stage procedure including a subtrochanteric proximal femoral resection and a musculocutaneous flap.

Detection of temporal lobe epilepsy using support vector machines in multi-parametric quantitative MR imaging

The detection of MRI abnormalities that can be associated to seizures in the study of temporal lobe epilepsy (TLE) is a challenging task. In many cases, patients with a record of epileptic activity do not present any discernible MRI findings. In this domain, we propose a method that combines quantitative relaxometry and diffusion tensor imaging (DTI) with support vector machines (SVM) aiming to improve TLE detection. The main contribution of this work is two-fold: on one hand, the feature selection process, principal component analysis (PCA) transformations of the feature space, and SVM parameterization are analyzed as factors constituting a classification model and influencing its quality. On the other hand, several of these classification models are studied to determine the optimal strategy for the identification of TLE patients using data collected from multi-parametric quantitative MRI.A total of 17 TLE patients and 19 control volunteers were analyzed. Four images were considered for each subject (T1 map, T2 map, fractional anisotropy, and mean diffusivity) generating 936 regions of interest per subject, then 8 different classification models were studied, each one comprised by a distinct set of factors. Subjects were correctly classified with an accuracy of 88.9%. Further analysis revealed that the heterogeneous nature of the disease impeded an optimal outcome. After dividing patients into cohesive groups (9 left-sided seizure onset, 8 right-sided seizure onset) perfect classification for the left group was achieved (100% accuracy) whereas the accuracy for the right group remained the same (88.9%).We conclude that a linear SVM combined with an ANOVA-based feature selection+PCA method is a good alternative in scenarios like ours where feature spaces are high dimensional, and the sample size is limited. The good accuracy results and the localization of the respective features in the temporal lobe suggest that a multi-parametric quantitative MRI, ROI-based, SVM classification could be used for the identification of TLE patients. This method has the potential to improve the diagnostic assessment, especially for patients who do not have any obvious lesions in standard radiological examinations.

Periprosthetic joint infections: a clinical practice algorithm

periprosthetic joint infection (PJI) accounts for 25% of failed total knee arthroplasties (TKAs) and 15% of failed total hip arthroplasties (THAs). The purpose of the present study was to design a multidisciplinary diagnostic algorithm to detect a PJI as cause of a painful TKA or THA. from April 2010 to October 2012, 111 patients with suspected PJI were evaluated. The study group comprised 75 females and 36 males with an average age of 71 years (range, 48 to 94 years). Eighty-four patients had a painful THA, while 27 reported a painful TKA. The stepwise diagnostic algorithm, applied in all the patients, included: measurement of serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels; imaging studies, including standard radiological examination, standard technetium-99m-methylene diphosphonate (MDP) bone scan (if positive, confirmation by LeukoScan was obtained); and joint aspiration with analysis of synovial fluid. following application of the stepwise diagnostic algorithm, 24 out of our 111 screened patients were classified as having a suspected PJI (21.7%). CRP and ESR levels were negative in 84 and positive in 17 cases; 93.7% of the patients had a positive technetium-labeled bone scan, and 23% a positive LeukoScan. Preoperative synovial fluid analysis was positive in 13.5%; analysis of synovial fluid obtained by preoperative aspiration showed a leucocyte count of > 3000 cells μ/l in 52% of the patients. the present study showed that the diagnosis of PJI requires the application of a multimodal diagnostic protocol in order to avoid complications related to surgical revision of a misdiagnosed "silent" PJI. Level IV, therapeutic case series.

Interventional Ductoscopy for Pathological Nipple Discharge

Despite the low likelihood of malignancy, it is recommended that patients who have pathologic nipple discharge (PND) undergo duct excision. Intraductal papilloma is well-known most frequent cause of PND. Our goal is to determine whether the ductoscopic retrieval of a solitary papilloma is feasible and/or therapeutic for patients with PND. The accompanying video demonstrates this interventional ductoscopic approach. Consented patients who had been diagnosed with PND were recruited to have ductoscopic exploration. Patients with palpable masses and suspicion of malignancy on ultrasound or mammography were excluded. Under local anesthesia, ductoscopy was performed using LaDuScope-T flex with an outer diameter of 1.1 mm, which allows extraction of a single papilloma with a microbasket (380 μm) via a working channel. Patients with sessile single papilloma or failure on ductoscopic extraction underwent ductoscopically guided microductectomy. Success was determined by recurrence of PND and by standard radiological examinations. Three patients presented in the video had negative cytology and normal conventional diagnostic imaging. Two patients diagnosed with a nonsessile single papilloma underwent successful ductoscopic extraction. The interventional examination times of those patients were 30 and 35 min. Patient who had a sessile papilloma underwent ductoscopically guided microductectomy. These patients had no recurrence of discharge or suspicious of malignancy after 5 years follow-up. Interventional ductoscopy provides an incisionless therapeutic option for patients diagnosed with a papillary nonsessile benign lesion that causes PND.

Relationships between young stallions’ temperament and their behavioral reactions during standardized veterinary examinations

Abstract Horse handling and veterinary examination can induce hazardous stress reactions. Such reactions occur especially in young and less-trained horses, particularly stallions, and make their handling a risk for breeders, grooms, and medical staff. Moreover, these stressful situations will affect the animal's health and welfare. Because stress reactivity is thought to be partly determined by genetic factors, scientists, veterinarians, and breeders are likely to be interested in adding temperament assessments to stallion selection schemes, as it is already done in some countries. This study assesses young stallions' temperament and its comparison with their stress reactions during a standardized veterinary examination for studbook admission. The assessment consists of a general examination, a lameness examination including flexion tests, an endoscopy of the upper airway, and a standardized radiological examination. During the years 2008 and 2009, 93 stallions were evaluated. Stallions were observed from the moment they were unloaded from the trailer at the clinic until the end of veterinary examinations. In addition to the behavioral observations made by the experimenter, each staff member in charge of the examination filled in a short questionnaire about the horse's temperament and the easiness of manipulation for the performed examinations. Breeders were asked to complete a longer questionnaire about their horse's temperament. The assessments of aggressiveness, sociability, and learning level temperament traits were the most consistent, as shown by the significant Spearman correlations between judges' assessments. Undesirable behaviors during veterinary examinations leading to handling difficulties were associated with a low easiness of manipulation score assessed by the clinical staff. These low easiness of manipulation scores were positively correlated to temperament traits such as anxiousness and aggressiveness and negatively correlated to others such as sociability or learning level. Temperament assessment and behavioral observations can therefore be used to anticipate behaviors that make a horse difficult to handle during veterinary examinations. Thus, it may be important to include temperament assessment as a feature in the selection of breeding stallions—as already practiced for some breeds in some countries. Such evaluations may promote the welfare of horses and ease of handling as well as safety for the handler.

Complication of mandibular third molars extraction: a case report

Objective: the objective of this paper is to show through a clinical case that an adequate clinical and radiographic examination should be performed before third molar removal to avoid complications especially the displaced tooth.Methods: the authors present a case report of a submandibular displacement of a mandibular third molar during extraction.Results: after standard radiological examination and a computed tomography (CT-scan) surgery for retrieving the displaced tooth was performed under general anesthesia without difficulty.Conclusion: localization with CT-scan and proper surgical methods are the keys to retrieving the displaced tooth but we must to remind dentists on ways to prevent and manage this complication.

Accuracy of point-of-care ultrasound for identifying fractures in patients with orthopaedic trauma presenting to emergency department of the All India Institute of Medical Sciences, level 1 trauma centre

Abstract Background Radiography is the standard observation tool for examining orthopaedic injuries. Point-of-care ultrasonography may thus be a faster, non-invasive alternative to effectively identify bone fractures in the emergency department (ED) setting. The study compares the diagnostic utilities of BUS and radiography for identifying long bone fractures. Methods Prospective observation study with convenience sampling was conducted in ED in patients above 5 years, with post-traumatic upper and lower limb injuries requiring standard radiological examination after informed consent. The BUS examinations were done by emergency physician (EP) who had a brief training session to detect fractures. For every subject, radiographs were taken and reviewed for the presence of fracture by blinded orthopaedic specialist. Statistical analysis was done by SPSS. Results One hundred and thirty-three patients were enrolled in the study. Only 42 had fracture, out of which 36 were picked up by BUS. The overall sensitivity of the BUS in detecting fracture was 85.7% with a confidence interval (CI) of 0.70–0.94 and specificity of 100% with a CI (0.95–1.00).The positive predictive value (PPV) of USG was 100% with a CI (0.86–1.00) and negative predictive value (NPV) of 93.8% with a CI (0.86–0.97). There were six additional fractures which were recognised on X-ray and were not picked up by ultrasound. Conclusion Point-of-care ultrasonography can be utilised by emergency physicians after brief training to accurately identify long bone fractures. It may gain a more prominent role in pregnant and paediatric population as well as in mass casualty scenarios.

(P2-72) Diagnostic Accuracy of Bedside Ultrasound for Identifying Fractures in Patients with Orthopedic Trauma Presenting to the Emergency Department of a Level-1 Trauma Center - Aims Ultrasound Fracture Study

BackgroundRadiography is the standard observation tool for examining orthopedic injuries. Bedside Ultrasound (BUS) may be a faster, non-invasive alternative to effectively identify bone fractures in the emergency department (ED) setting. The study compares the diagnostic utilities of BUS and radiography for identifying long bone fractures.MethodsProspective observation study with convenience sampling was conducted in ED in patients &gt; 5 years, with post-traumatic upper and lower limb injuries requiring standard radiological examination after informed consent. The BUS examinations were performed by a emergency physician (EP) who had a brief training session to detect fractures. For every subject, radiographs were taken and reviewed for the presence of fracture by blinded orthopedic specialist. Statistical analysis was done by SPSS.ResultsA total of 133 patients were enrolled in the study. Only 42 had fracture, out of which 36 were picked up by BUS. The overall sensitivity of the BUS in detecting fracture was 85.7% with a confidence interval (CI) of 0.70–0.94 and specificity of 100% with a CI = 0.95–1.00. The positive predictive value (PPV) of USG was 100% with a CI = 0.86–1.00 and negative predictive value (NPV) of 93.8% with a CI = 0.86–0.97. There were six additional fractures which were recognized on x-ray and were not picked up by ultrasound.ConclusionsBUS can be utilized by EP after brief training to accurately identify long-bone fractures. It may gain a more prominent role in pregnant and pediatric population as well as in mass-casualty scenarios.

Noninvasive ultrasonic measuring system for bone geometry examination

Bone deformities are typically identified through standard radiograms. Since X-ray examinations are easily applied and offer high quality imaging, noninvasive techniques are not commonly used in bone diagnostics. Nevertheless, nonradiological techniques are considered necessary because of the harmful effects of X-ray radiation. The paper presents a new noninvasive system for bone imaging. The system allows the physician to create self-defined templates of the measured geometrical parameters and to measure the bone geometry according to the planned procedures. The proposed system was verified by determining the fiducial location error, the fiducial registration error and the target registration error. The tests were performed on sawbones and a measuring plate. In order to verify the accuracy of reconstruction, tests on the three-dimensional phantoms were carried out. The system has been tested in clinical conditions: results of limb geometrical parameters measured on five probands were compared with MRI-based evaluation. The system supplies critical data supporting the standard radiological examination. In the future, after further improvements it may replace invasive X-ray imaging. The main advantage of ultrasonography is noninvasive imaging (using mechanical waves), however, it demands considerable experience.