Use Of Plain Radiographs Research Articles

Use of Plain Radiography in the Diagnosis, Surgical Management, and Postoperative Treatment of Obstructive Urolithiasis in 25 Goats and 2 Sheep

To describe use of plain radiography for diagnosis, surgical management, and postoperative treatment of obstructive urolithiasis in small ruminants. Retrospective case series. Small ruminants (n = 27; 25 goats, 2 sheep). Medical records (January 2002-November 2011) and radiographs for all small ruminants diagnosed with obstructive urolithiasis and having plain abdominal radiographs were reviewed. Signalment, surgical procedures, radiographic findings, ultrasonographic findings, position of calculi, and how plain radiography influenced surgical management and postoperative treatment were recorded. Radiopaque urinary calculi were detected in 23 (85%) plain radiographic studies. Location of uroliths determined by plain radiography included: cystic only (n = 5), distal to the sigmoid flexure and cystic (5), subischial (5), distal to the sigmoid flexure only (3), sigmoid flexure (3), and subischial and cystic (2). In 8 of these animals, postoperative radiographs revealed residual calculi in the urethra and were essential for their targeted removal by urethrotomy in 7 animals. In regions where radiopaque calculi (calcium carbonate, calcium oxalate, silica) are commonly encountered in small ruminants, plain radiographs are recommended to determine the appropriate surgical approach(es) and to confirm resolution of the obstruction.

Echocardiography allows more accurate placement of peripherally inserted central catheters in low birthweight infants

The use of plain radiographs provides limited information on the placement of peripherally inserted central catheters (PICCs). Moreover, changes in upper extremity positioning cause migration of the catheters in neonates. This study aimed to investigate the use of echocardiography for determining catheter tip position, compared with plain radiographs, in low birthweight (LBW) infants in a tertiary neonatal intensive care unit. The study examined the placement of 109 catheters in 89 infants born between September 2010 and December 2012. The placement of these catheters was controlled by echocardiography, with the patient's shoulder in adduction and the elbow in flexion. The number of catheter tips, echocardiographically identified within the heart, was expressed as a percentage of the total catheters deemed to be well positioned on plain radiographs. The number of catheter tips that were echocardiographically identified within the heart was significant (25%, p < 0.001). Twenty-three catheters were repositioned to be outside of the heart, without any complications. This study demonstrated the value of echocardiography for identifying the positioning of catheter tips in LBW infants. Echocardiography, coupled with initial plain radiographs, should be the gold standard for assessing PICC tip positions in those infants.

Histopathological correlation supports the use of x-rays in the diagnosis of hand osteoarthritis

ObjectiveTo correlate histopathological and radiographic features of distal and proximal interphalangeal (DIP and PIP) joints in order to test whether the use of an x-ray examination would be beneficial to...

Syndrome d’Eagle

Eleven cases of Eagle's syndrome or long styloid process syndrome are presented. It is a rare entity, which is not commonly suspected in clinical practice. Symptoms were dull and persistent pharyngeal pain, dysphagia, and facial pain.In addition to careful clinical examination, the use of plain radiographs, orthopantomograms or CT scan has allowed accurate preoperative diagnosis of this syndrome. Surgical treatment has positively resolved the symptoms in these cases. The International literature is discussed regarding anatomy, symptoms and treatment of the long styloid process syndrome.

Measuring Acetabular Component Version After THA: CT or Plain Radiograph?

Although cross-table lateral radiographs are commonly used to measure acetabular component version after THA, recent studies suggest that CT-based measurement is more accurate. This has been attributed to variations in pelvic tilt, pelvic rotation, and component inclination. Furthermore, it has been suggested, based on limited data, that even with ideal positioning of the cross-table lateral radiograph, CT remains the more accurate modality. We determined whether appropriately positioned cross-table lateral radiographs could provide accurate measurements of acetabular component version, and compared accuracy and reliability of measurements from modified cross-table lateral radiographs with those from standard cross-table lateral radiographs and CT. We implanted 27 Sawbones pelves with an acetabular cup using computer navigation. CT, an AP view of the pelvis, and cross-table lateral and modified cross-table lateral radiographs were performed for each specimen. For the modified cross-table lateral radiograph, the beam angle varied based on the cup inclination as measured on an AP view of the pelvis. Two independent observers measured acetabular component version and inclination. We calculated intraobserver and interobserver reliabilities for each method and compared these with values obtained from navigation presuming that to be the standard for judging accuracy. Interobserver and intraobserver reliabilities were greater than 0.95 (95% CI, 0.904-0.999) for all measurements. Correlation with navigated values was 0.96 or greater (95% CI, 0.925-0.998) for all methods. Although CT had the highest correlation with navigated values, the correlations for the modified cross-table lateral and cross-table lateral radiographs were similar. CT allows for accurate measurement of acetabular component version; however, when properly positioned, cross-table lateral radiograph-derived measurements are similarly accurate. Our results support the use of plain radiographs to obtain important measurements after THA.

The Use of Targeted Neonatal Echocardiography to Confirm Placement of Peripherally Inserted Central Catheters in Neonates

The use of plain radiographs in assessing the correct position of peripherally inserted central catheter (PICC) line tips is not always accurate. Ultrasound may be a better modality in detecting tip position and aid in line manipulation. We assessed the accuracy of plain radiographs in determining PICC line tip position compared with using targeted neonatal echocardiography (TnECHO) in a tertiary neonatal intensive care unit. Following PICC insertion, tip position was confirmed using TnECHO after the first radiograph. A 2 × 2 table was constructed to compare the two modalities' ability to detect line position. A total of 22 infants were included in the study with a gestation of 26.5 weeks (25.4 to 28.8) and birth weight of 833 g (710 to 1930). Concordance between radiographs and TnECHO for PICC line tip position occurred in 13 infants (59%). Sensitivity of radiographs in determining malposition was 64% with a specificity of 55%. Three infants were incorrectly identified to have deep lines and two infants were incorrectly identified to have short lines. In nine infants (41%), a second radiograph was avoided following line manipulation using TnECHO. TnECHO is a useful tool in identifying tip position, performing real-time manipulation, and minimizing exposure to further radiographs.

‘Clearing’ the cervical spine in the unconscious trauma patient

This is a systemic review of the published evidence regarding cervical spine management in unconscious trauma patients. We examine the literature in the following sections: use of plain radiography; use of flexion/extenson views; use of computed tomography; use of magnetic resonance imaging. We also review surveys of practice and current guidelines. In contrast to the conscious trauma patient there have been no large prospective multicentre studies to derive a clinical decision rule for the exclusion of cervical spine injury. This review therefore assesses currently available evidence to reach a logical conclusion regarding the most appropriate imaging strategy to exclude significant injury in the cervical spine, whilst minimising the time that a patient needs to remain immobilised.

Radiographic and Endoscopic Diagnosis and Treatment of Enterocutaneous Fistulas

The management of enterocutaneous fistulas continues to be a challenging postoperative complication. Understanding the anatomy of the fistula optimizes its evaluation and management. Diagnostic radiology has always played an important role in this task. The use of plain radiography with contrasted studies and fistulograms is well documented in the earliest investigations of fistulas and they continue to be helpful techniques. The imaging techniques have evolved rapidly over the past 15 years with the introduction of cross-sectional imaging, ultrasound and endoscopy. The purpose of this chapter is to review both the diagnostic and therapeutic roles of fistulograms, small bowel follow-through, computed tomography, magnetic resonance imaging, ultrasound, and endoscopy in the setting of acquired enterocutaneous fistulas.

Addressing “Waste” in Diagnostic Imaging: Some Implications of Comparative Effectiveness Research

Comparative effectiveness research is intended to provide evidence to improve patient outcomes through the use of the most appropriate health technology affordable. The authors present 5 case studies, focusing on the use of plain radiography in common clinical scenarios, to illustrate the considerable scope for comparative effectiveness research within medical imaging and the different levels of evidence currently in existence to guide the improved use of medical imaging. These are blunt ankle injury, breast cancer follow-up, low back pain, routine daily chest x-rays in intensive care, and screening for breast cancer. Although there are established models for evaluating new technologies, especially pharmaceuticals, against the most commonly used current technology, the evaluation of technologies in current clinical practice is in an early phase of development. Because evaluation resources are limited, one major challenge is developing ways to identify established technologies for evaluation to refine the indications for their use. A set of criteria with which to identify established technologies that may not be delivering value for money is described, and their use is illustrated in relation to the 5 case studies. These criteria could be incorporated into literature search strategies, stakeholder consultations, and utilization scanning. Once identified, these technologies should be formally evaluated for their performance in improving patient health without restricting the availability of other effective interventions.

Pelvis Insufficiency Fracture after Total Knee Arthroplasty

Pelvic insuffi ciency fracture is a very rare complication after total knee arthroplasty (TKA). This fracture occurs in elderly osteoporotic patients, spontaneously or after minor trauma, and its diagnosis can be diffi cult unless there is a high degree of clinical sus picion. The consequence of missed pelvic insuffi ciency fracture can be profound: this fracture may progress into an unstable fracture t hat leads to signifi cant disability. Bone scans assist in the early diagnosis of this fracture. We present a case of osteoporotic p elvic insuffi ciency fracture after bilateral TKA. A 76 year-old female underwent bilateral TKA for advanced osteoarthritis in her bot h knees. She also had osteoporosis, and thus we fi lled an oral bisphosphonate (weekly Risedronate) prescription. Nine months after TKAs, she presented with signifi cant pain around the left buttock and inguinal area without specifi c trauma. With the use of plain radiog raphs and a bone scan, a pelvic insuffi ciency fracture was detected. We successfully treated the patient with conservative management including rest with a pelvic strap, and continued medication for osteoporosis.

A novel method for describing orbital floor and wall fractures

Considerable data exists surrounding the assessment, investigation, and surgical correction of fractures of the orbital floor and wall. Clinical examination and measurement of enophthalmos are often augmented with Hess charts, measurement of binocular single vision (BSV), and use of plain radiographs. More recently magnetic resonance imaging (MRI) and in particular computed tomography (CT) have become the investigations of choice before and after operation to assess size, site, and change in the volume of orbital defects.

Treatment of Scaphoid Waist Nonunions with an Avascular Proximal Pole and Carpal Collapse

Surgically, it is difficult to achieve union of a scaphoid nonunion that is associated with osteonecrosis of the proximal pole, and those with carpal collapse are especially difficult to treat. A variety of vascularized bone grafts can be used. The purpose of this study was to compare the effectiveness of two types of vascularized bone graft -- a distal radial pedicle graft and a free vascularized medial femoral condyle graft -- in the treatment of scaphoid waist nonunions associated with proximal pole osteonecrosis and carpal collapse. A retrospective review was conducted at two institutions to identify all patients with a scaphoid waist nonunion associated with an avascular proximal pole and carpal collapse. Between January 1994 and June 2006, twenty-two such nonunions were identified in twenty-two patients. Ten were treated with a distal radial pedicle vascularized graft and twelve, with a free vascularized medial femoral condyle graft. Patient demographics were similar between the groups, and the duration of follow-up averaged twelve months. Union was determined with use of plain radiographs and computed tomography or trispiral tomograms. In addition, carpal angles, time to union, union rates, and complications were recorded. Four of the ten nonunions treated with the distal radial pedicle graft healed, at a median of nineteen weeks, and all twelve nonunions treated with the free medial femoral condyle graft healed, at a median of thirteen weeks. The rate of union was significantly higher (p = 0.005) and the median time to healing was significantly shorter (p < 0.001) for the nonunions treated with the medial femoral condyle graft. A vascularized interposition graft from the medial femoral condyle is the recommended vascularized bone graft for the surgical treatment of scaphoid waist nonunion with avascularity of the proximal pole and carpal collapse.

Cervical spine clearance in obtunded patients after severe polytrauma

To provide clinicians with data supporting three different clearance techniques in the obtunded patients after severe polytrauma. This study gave an overview of the available and pertinent literature regarding cervical spine clearance in obtunded patients after severe polytrauma. Currently, there were three accepted techniques for clearance of the cervical spine in obtunded patients after severe polytrauma. Each of these methods has advantages and disadvantages to both of the patients and the clinicians. There are continuous improvements in both computed tomography (CT) and magnetic resonance imaging (MRI) techniques that increase their sensitivities. The continued use of plain radiographs is called into question with respect to cost and time requirements. An algorithmic approach to the evaluation of the cervical spine in the obtunded patients will lead to fewer missed injuries.

Injuries of the distal lower extremity syndesmosis

ABSTRACTInjuries to the distal tibiofibular syndesmosis are common and can lead to prolonged disability. The diagnosis of these injuries is not always straightforward. The recent literature has examined the use of plain radiographs, MRI, arthroscopy and intraoperative fluoroscopy in the diagnosis of

`Clearing' the cervical spine in conscious trauma patients

This is a systematic review of published evidence regarding management of the cervical spine in conscious and co-operative trauma patients. We examine the literature in the following sections: clinical evaluation of the cervical spine; use of plain radiography; use of additional radiographic views; use of computed tomography; use of magnetic resonance imaging. Finally we consider the elderly and paediatric populations, particularly where there are significant differences compared to the general adult population. This paper also reviews the literature regarding non-medical assessment of the cervical spine. We conclude that there are well-validated decision rules available to guide the clinician, and that each imaging strategy has distinct advantages and disadvantages. Familiarity with these issues provides a sound basis for safe and effective decision-making.

Treatment of Scaphoid Waist Nonunions with an Avascular Proximal Pole and Carpal Collapse

Surgically, it is difficult to achieve union of a scaphoid nonunion that is associated with osteonecrosis of the proximal pole, and those with carpal collapse are especially difficult to treat. A variety of vascularized bone grafts can be used. The purpose of this study was to compare the effectiveness of two types of vascularized bone graft--a distal radial pedicle graft and a free vascularized medial femoral condyle graft--in the treatment of scaphoid waist nonunions associated with proximal pole osteonecrosis and carpal collapse. A retrospective review was conducted at two institutions to identify all patients with a scaphoid waist nonunion associated with an avascular proximal pole and carpal collapse. Between January 1994 and June 2006, twenty-two such nonunions were identified in twenty-two patients. Ten were treated with a distal radial pedicle vascularized graft and twelve, with a free vascularized medial femoral condyle graft. Patient demographics were similar between the groups, and the duration of follow-up averaged twelve months. Union was determined with use of plain radiographs and computed tomography or trispiral tomograms. In addition, carpal angles, time to union, union rates, and complications were recorded. Four of the ten nonunions treated with the distal radial pedicle graft healed, at a median of nineteen weeks, and all twelve nonunions treated with the free medial femoral condyle graft healed, at a median of thirteen weeks. The rate of union was significantly higher (p = 0.005) and the median time to healing was significantly shorter (p < 0.001) for the nonunions treated with the medial femoral condyle graft. A vascularized interposition graft from the medial femoral condyle is the recommended vascularized bone graft for the surgical treatment of scaphoid waist nonunion with avascularity of the proximal pole and carpal collapse.

Functional and Radiographic Outcome of Stable Juvenile Osteochondritis Dissecans of the Knee Treated With Retroarticular Drilling Without Bone Grafting

The purpose of this study was to evaluate the functional and radiographic outcome of retroarticular drilling for patients with juvenile osteochondritis dissecans after 6 months of unsuccessful nonoperative treatment. A total of 20 osteochondritis dissecans lesions in 12 skeletally immature patients were treated with retroarticular drilling without bone grafting. There were 10 boys and 2 girls with a mean age of 12.0 years (range, 9 to 15 years). The functional outcomes were evaluated by use of the Lysholm score at a mean follow-up of 2.7 years after drilling, and healing of the lesions was confirmed by use of plain radiographs and magnetic resonance imaging. The mean Lysholm score significantly improved postoperatively (from 72.3 to 95.8). All lesions except 1 healed after retroarticular drilling. Healing was achieved at a mean of 4.4 months on plain radiographs and 7.6 months on magnetic resonance imaging. This study shows that retroarticular drilling without bone grafting leads to improved clinical outcomes and high healing rates. We advocate retroarticular drilling for patients with stable juvenile osteochondritis dissecans of the knee whose initial nonoperative treatment has failed.

Variability in the assessment of fracture-healing in orthopaedic trauma studies.

There is a lack of consensus among orthopaedic surgeons in the assessment of fracture-healing. We conducted a systematic review of recent clinical studies of long-bone fracture care that were published in three major orthopaedic journals to identify current definitions of fracture-healing. MEDLINE and the computerized databases for The Journal of Bone and Joint Surgery (American Volume), The Journal of Bone and Joint Surgery (British Volume), and the Journal of Orthopaedic Trauma were searched from January 1996 through December 2006 with use of title, abstract, keyword, and medical subject headings. Therapeutic clinical studies of long-bone fractures of the appendicular skeleton in adults in which fracture-healing was assessed were selected. Two reviewers independently identified articles and extracted data. Any disagreement was resolved by consensus. We qualitatively and quantitatively summarized the definition of fracture union and the reliability of the assessment of radiographic fracture-healing. One hundred and twenty-three studies proved to be eligible. Union was defined on the basis of a combination of clinical and radiographic criteria in 62% of the studies, on the basis of radiographic criteria only in 37%, and on the basis of clinical criteria only in 1%. Twelve different criteria were used to define fracture union clinically, and the most common criterion was the absence of pain or tenderness at the fracture site during weight-bearing. In studies involving the use of plain radiographs, eleven different criteria were used to define fracture union, and the most common criterion was bridging of the fracture site. A quantitative measure of the reliability of the radiographic assessment of fracture union was reported in two studies. We found a lack of consensus with regard to the definition of fracture-healing in the current orthopaedic literature. Without valid and reliable clinical or radiographic measures of union, the interpretation of fracture care studies remains difficult.

Recent Trends in Utilization Rates of Abdominal Imaging: The Relative Roles of Radiologists and Nonradiologist Physicians

To study recent trends in the utilization of abdominal imaging in the Medicare population. The Medicare Part B databases for 1996 through 2005 were reviewed, and all Current Procedural Terminology, 4th ed, codes pertaining to noninvasive imaging of the abdomen and pelvis were identified. The codes were grouped into 6 categories: (1) computed tomography (CT) and CT angiography, (2) magnetic resonance (MR) and MR angiography, (3) ultrasound, (4) radionuclide imaging, (5) plain radiography, and (6) gastrointestinal fluoroscopy. Global and professional-component claims from all places of service were tabulated for the 6 categories. Utilization rates per 1,000 Medicare fee-for-service beneficiaries were calculated. Medicare physician specialty codes were used to identify examinations by radiologists and nonradiologist physicians. Overall utilization trends were studied, as were those among radiologists and nonradiologists. In 1996, an overall total of 451.8 abdominal imaging examinations were performed per 1,000 Medicare beneficiaries, increasing to 564.5 in 2005 (+25%). The greatest growth was seen in computed tomography and computed tomographic angiography, which rose from 99.4 examinations in 1996 to 239.3 in 2005 (+141%). Ultrasound increased from 126.6 examinations in 1996 to 142.2 in 2005 (+12%). Plain abdominal radiographic examinations decreased from 144.1 to 125.4 (-13%), and gastrointestinal fluoroscopic examinations decreased from 67.3 to 34.8 (-48%). The utilization of MR and MR angiography and radionuclide imaging was far lower. Radiologists' market share of abdominal imaging was 88% in 1996 and 90% in 2005. Between 1996 and 2005, the utilization rate among radiologists increased by 29%, compared with 11% among nonradiologist physicians. In recent years, the increase in the utilization rate of abdominal imaging among the Medicare population was relatively moderate (25% over 9 years). There was a substantial increase in the use of computed tomography and computed tomographic angiography and a smaller increase in the use of ultrasound. The use of plain radiography and gastrointestinal fluoroscopy declined. Radiologists strongly predominate in abdominal imaging, and this may be one reason why growth has been modest.

Mild head injuries: prospective study

Background To define the incidence of positive CT scans in patients with different grades of mild head injury (MHI), 2. To identify clinical predictors of positive CT scans, 3. To evaluate the usefulness of plain radiographs in the triage of patients with MHI, 4. To evaluate frequency and nature of surgical intervention in MHI, 5. To evaluate the risk of deterioration in MHI, and 6. To find out whether patients with normal neurological examination and normal CT can be safely discharged.