X-ray Department Research Articles

Subarachnoid haemorrhage and intracranial aneurysms in Greenland in the period 2018–2021: incidence, outcome and familial disposition

ABSTRACT Subarachnoid haemorrhages (SAH) caused by rupture of intracranial aneurysms (IA) are a severe condition. Earlier studies found a higher incidence of SAH in Greenlandic patients compared to Danish patients, with familial aggregation also higher in Greenland. However, updated data is lacking. To investigate the contemporary incidence, outcome, and familial disposition of SAH/IA in Greenlandic patients in 2018–2021. Greenlandic patients diagnosed with ruptured or unruptured IA (UIA) during 2018–2021 were included. Data was obtained from patient files, x-ray department, and discharge registry. Incidence rates were estimated as cases/100,000/year. Direct age-standardised incidence rates were calculated using WHO 2000–2025 as standards. Of 30 SAH patients, 20 (66.7%) were females, 10 (33.3%) males. Of 36 UIA patients, 27 (75.0%) were females, 9 (25.0%) males. For SAH, crude incidence was 13.4/100,000/year, age-standardised incidence was 10.8/100,000/year. Familial history was observed in 30.0% of SAH patients. 5 patients (16.7%) died before treatment, 28-day case-fatality rate (CFR) for all patients was 23.3%. Overall and age-standardised incidence rates were similar to previous studies but higher among females and compared to neighbouring countries. A high occurrence of familial history was reported. SAH remains a serious condition in Greenland, as evidenced by five fatalities before treatment was administered.

Determination of Demographic, Systemic, and Radiographic Characteristics of Patients Applied to the Oral and Maxillofacial Radiology Clinic

Objective: Anamnesis, extraoral intraoral examination, radiographic examination, and other special examination methods are used to diagnose diseases in the oral and maxillofacial regions. The aim of this study was to establish the demographic, systemic, and radiographic characteristics of the patients by analyzing the records of patients who were treated at the Oral and Maxillofacial Radiology Clinic of the University Faculty of Dentistry. Methods: The anamnesis and diagnostic records of patients who were treated at the OMR clinic between 01.01.2013 and 31.12.2019 and the radiographic records of the patients referred to the X-ray department were retrospectively analyzed. The number of patients was analyzed according to demographic, systemic, and radiographic classifications, and tables were created according to years and total numbers. Results: The number of females who applied between 2013-2019 was statistically significantly higher than that of males. When the age distribution of all patients who applied to the OMR clinic was analyzed, it was observed that the patients who applied were 15 years of age and older, and 29.3% of these patients were in the 30-44 age group, with the highest proportion. When radiographic data were analyzed, it was observed that the most common radiograph obtained was a panoramic radiograph (90%). Conclusion: Anamnesis records revealed the systemic disease characteristics of the study area, which is helpful for diagnosis and treatment planning. The most requested radiographic types and clinics that requested the most radiographs were determined. This will help improve the functioning within and between departments. By determining the common diagnoses in panoramic radiographs, the issues to be considered in patients of certain age and sex groups have been clarified.

Radiographer experiences of personal protective equipment during COVID-19 in Gauteng, South Africa

IntroductionAmidst the COVID-19 pandemic, healthcare workers (HCWs) were found to be at a greater risk of becoming infected with severe acute respiratory syndrome (SARS-CoV-2). This disease is highly contagious and is for the most part preventative if correct Personal Protective Equipment (PPE) is used while attending to patients. Subsequently, a lack of PPE in South Africa was putting the lives of health care workers at risk impacting on the functioning of the healthcare system. MethodsThis exploratory, descriptive, qualitative study used purposeful sampling to obtain data saturation. The study comprised twelve individual interviews with radiographers from both private and government hospitals in Gauteng, South Africa who worked in x-ray departments during the COVID-19 pandemic. Online video interviews were conducted. The transcripts of the interviews were further coded into themes and categorised using thematic analysis and verified by an independent coder. ResultsThe radiographers’ experiences of PPE during COVID-19 in Gauteng, South Africa generated 3 themes: radiographers’ experiences with PPE supplied during COVID-19, workplace practices and procedures for PPE during COVID-19 and emotional challenges faced during PPE shortage. DiscussionWhile there was an understandable fear of contracting the COVID-19 virus during the height of the pandemic. The researcher also believes that radiographers would benefit greatly by receiving training on how to use PPE correctly for infection control in highly stressful situations. Education is required for use of PPE when supply is scarce and the number of infected patients outweighs the quantities of PPE available. This study further found that there needs to be more support given to healthcare workers (HCW's) to assess their mental health and emotional stress experienced when facing a pandemic. ConclusionWhile COVID-19 has started to settle, the lessons learnt should inform recommendations on PPE use, regarding procurement and preservation. In addition, mental health assessments can be considered for radiographers during future pandemic.

Radiation Pollution Hazard Indices in Hospitals of Hilla City/Iraq

Background
 High radiation is a double-edged sword, may be a treatment for some diseases also it may be dangerous when exposed to it in large doses for long periods of time, hospitals are a good example of this, hospitals are cure for patients and at the same time its considered a disease for their workers. 
 Materials and Methods:
 Giger-Muller instrument counter was used to calculate the level of radioactivity emanating from three hospitals in Babel / Al-Hillah. Radioactivity was measured in different areas of each hospital, especially the X-ray departments, accelerators and CT-scan room.
 Results:
 The result is that the data we obtained were within the permissible exposure levels. Determine the most radioactive areas in the study area, the highest value was recorded in (0.90 mSv) in X-ray device in Hilla Surgical Hospital and the lowest dose was (0.015 mSv) in the X-ray device in Imam Al-Sadiq Hospital.
 Conclusion:
 Several samples investigated were less than the safe limits recommended by WHO in some respects.

COMPARISON OF RADIOGRAPHIC METHODS (THE GILSANZ AND RATIBIN ATLAS AND TANNER-WHITEHOUSE 2 AND 3) OF BONE AGE ASSESSMENT WITH CHRONOLOGICAL AGE

Introduction: Bone age assessment (BAA) can play an important role in legal and medical contexts. It can help determine a person’s legal rights and responsibilities, and can also be used to estimate their chronological age (CA) when accurate birth records are not available. BAA is used in situations such as identification, employment, criminal responsibility, judicial punishment, consent for marriage, and in sports competitions. In addition, it can also be used in cases where there is a need to estimate CA, such as during immigration or in conditions where birth records are not available. Methods: The study was approved by the Institutional Ethical Committee, and written consent was obtained from both children and their parents before participating in the study. Patients were selected based on specific inclusion and exclusion criteria. A data collection form was created for each participant. X-rays of the left hand and wrist were taken for all children referred to the X-ray Department at Sahyadri Speciality Hospital in Pune. The CA of the child was determined by their date of birth, and the bone age (BA) was assessed using radiographic methods. Result: The Bland–Altman plot is a statistical tool used to compare the agreement between two methods of measurement, in this case, the CA and Tanner-Whitehouse 2 (TW3) methods for BAA. The results of the comparison showed a statistically significant agreement between the TW3 method and the GR atlas. Conclusion: The TW2 method is not reliable for BAA. However, the TW3 method is considered reliable for assessing BA in older male children (ages 105–192 months) and younger female children (ages 13–104 months). On the other hand, the GR atlas appears to be more effective for younger male children (ages 13–104 months) and older female children (ages 105–192 months). In addition, the TW3 method can be used in conjunction with the GR atlas for older female children.

Job satisfaction among general radiographers and assistant practitioners: a mixed-methods survey

Background/Aims Maintaining staff satisfaction is a major ambition for healthcare leaders worldwide, as it is directly linked with patient outcomes. Despite this, there is a dearth of literature on the job satisfaction of radiographers. This study aimed to explore the job satisfaction and role perceptions of radiographers and assistant practitioners at a local district general hospital. Methods All radiographers and assistant practitioners (n=39) working in the general X-ray department of a small-medium sized NHS trust were invited to complete either an online or physical copy of a semi-structured, mixed-methods questionnaire regarding their job satisfaction and perceptions of their role. Items included quantitative (multiple choice) and qualitative (free-text) questions. Quantitative data were analysed using descriptive statistics while qualitative data were analysed using content analysis. Results A total of 21 individuals completed the questionnaire, giving a 53.8% response rate. The mean score for happiness in their current role was fairly high at 7.3/10, but staff with more experience had lower average happiness scores relating to their role and working hours. Respondents were confident working in most clinical areas, including mobile units, but lacked confidence working in computed tomography and fluoroscopy. Conclusions Strategies are needed to understand and address issues that may be causing more experienced radiography staff to experience less happiness in their job role. Lack of experience in computed tomography and fluoroscopy also needs to be addressed, possibly by ensuring that radiography staff regularly work in these areas to build their confidence.

Three Zone Scanning Protocol For Lung Ultrasound: An Anatomical Basis.

Lung ultrasound is rapidly gaining popularity based on point of care ease of use, diagnostic fidelity and lack of ionizing radiation. This was particularly notable at the beginning of the COVID-19 pandemic, where concerns of contamination of the x-ray department led to a reluctance to order frequent chest x-rays. Early COVID-19 lung involvement is of a bronchopneumonia, and patches of consolidation adjacent to the chest wall were easily detectable by ultrasound. A large number of proposed scanning protocols were advocated and are often complex and largely based on traditional stethoscope examination or access points on the chest wall rather than the underlying lung anatomy. A surgical understanding of lung anatomy and related surface anatomy has led us to develop a simplified three zone scanning protocol in 2013. The anterior zone corresponds to the upper lobe, and the posterior zone is divided between upper lobe and lower lobe. The relationship between lung lobes and the surface of the chest wall provides the anatomical basis for a simple three scanning zone lung ultrasound protocol.

Correlation between mAs and ESAK (mGy) for male and female chest x-ray in Digital radiography

The data were collected from 350 patients, who underwent routine x-ray examinations for chest PA examination with digital imaging in the x-ray department of Alshab Teaching Hospital in Khartoum state in Sudan. During the period from November 2019 to February 2020. The data for optimization phase were collected from phantom from computed radiography, which include chest PA, chest AP in Karary University during the period from January 2020 to February 2020. It was passed successfully the extensive quality control tests performed by Sudan atomic energy commission. The objective was to correlate between mAs and ESAK (mGy) for male and female chest x-ray. The study concluded that there was a strong relationship between mAs and ESAK, also significant correlation between Age groups and incidence risk cancer and mortality.

Relationships between the inferior wall of maxillary sinus and the roots of the maxillary molars

The aim of the study is to evaluate the position of the roots of the first and second upper molars relative to the bottom of the maxillary sinus (maxillary sinus) according to cone-beam computed tomography (CBCT). The CBCT scans of 150 patients (69 men and 81 women) from the database of the X-ray department of the 11th City Clinical Hospital of Minsk who applied for dental care were studied. There are 4 variants of vertical relationships between the roots of the teeth and the lower wall of the maxillary sinus. At the contact of the molar roots and the bottom of the HPV, 3 variants of the horizontal relationship between the roots of the teeth and the bottom of the maxillary sinus in the frontal plane were identified. The root apices of the maxillary molars can be located below the level of the MSF (type 0; 16.69%), contact with MSF (types 1-2; 72%) or protrude into the sinus cavity (type 3; 11.31%) at a distance of up to 6.49 mm. The roots of the second maxillary molar showed greater proximity to the MSF than the first molar roots and more often protruded into the maxillary sinus. The most common type of horizontal relationship between the molar roots and the MSF, in which the lowest point of the MSF was located centrally between buccal and palatal roots. It was found that the proximity between the roots and the MSF correlates with maxillary sinus vertical dimension. This parameter was significantly greater in type 3 when the roots protruded into the maxillary sinus than in type 0, when there was no contact between the MSF and the root apices of the molar teeth. Significant individual variability in the anatomical relationships between the roots of the maxillary molars and the MSF indicates the need for the mandatory appointment of cone-beam computed tomography in preoperative planning for the extraction of these teeth and/or their endodontic treatment.

Shielding Adequacy of Conventional X-ray Facilities in Kano Metropolis, Nigeria using RadShield Software

Over time x-ray department gains more patient throughput compared to when it was established, this may lead to changes in room usage, workload and occupancy factor. Therefore, it becomes imperative to re-evaluate the shielding adequacy of the facilities to ensure the appropriate shielding design goal is accomplished. The study was aimed at assessing the shielding adequacy of conventional x-ray rooms in ten radio diagnostic centres in Kano Metropolis using RADSHIELD software. This was a prospective, cross-sectional study. RadShield software version 1.1 was used in the study, parameters such as distances of each wall from a radiation source (D), the average number of patients per week (N), occupancy factor (T), and use factor (U) were inserted into the software together with the shielding design goal (P). Once the result was generated, the design and shielding variables were saved in .xml format. The data were analyzed using Excel 2016. Ten facilities were studied involving 14 x-ray rooms. Room III had the largest room size of 49.2 m2 while room X had the least room size of 12.8 m2. Room II had the longest source image distance (SOD) of 180cm while room IV had the shortest (120cm). The design barrier thickness was thickest (47 cm) in room II and thinnest (1.5 cm) in barrier 5 of room III. All the x-ray rooms had the ideal room size except facilities G and H. The design barrier thickness in the radiology department of all the conventional x-ray rooms involved in the study was adequate.

Early stage of radiological expertise modulates resting-state local coherence in the inferior temporal lobe.

The visual system and its inherent functions undergo experience-dependent changes through the lifespan, enabling acquisition of new skills. Previous fMRI studies using tasks reported increased specialization in a number of cortical regions subserving visual expertise. Although ample studies focused on representation of long-term visual expertise in the brain, i.e. in terms of year, monthly-based early-stage representation of visual expertise remains unstudied. Given that spontaneous neuronal oscillations actively encode previous experience, we propose brain representations in the resting state is fundamentally important. The current study aimed to investigate how monthly-based early-stage visual expertise are represented in the resting state using the expertise model of radiologists. In particular, we investigated the altered local clustering pattern of spontaneous brain activity using regional homogeneity (ReHo). A cohort group of radiology interns (n=22) after one-month training in X-ray department and matched laypersons (n=22) were recruited after rigorous behavioral assessment. The results showed higher ReHo in the right hippocampus (HIP) and the right ventral anterior temporal lobe (vATL) (corrected by Alphasim correction, P<0.05). Moreover, ReHo in the right HIP correlated with the number of cases reviewed during intern radiologists' training (corrected by Alphasim correction, P<0.05). In sum, our results demonstrated that the early stage of visual expertise is more concerned with stabilizing visual feature and domain-specific knowledge into long-term memory. The results provided novel evidence regarding how early-stage visual expertise is represented in the resting brain, which help further elaborate how human visual expertise is acquired. We propose that our current study may provide novel ideas for developing new training protocols in medical schools.

An approach for the online determination of Entrance Surface Air Kerma (ESAK) from Kerma Area product (PKA) in digital radiology.

We propose determining the entrance surface air kerma (ESAK) from the kerma area product (PKA) in digital radiology. ESAK values were derived from the X-ray tube outputs and patient exposure factors across five X-ray departments. Using linear regression between ESAK and PKA values, the slope and intercept coefficients were determined for each X-ray equipment and procedure. The method was examined using the data collected from patients who underwent chest PA/LAT, abdomen, pelvic AP, and lumbar spine AP/LAT X-ray examinations. The results showed a highly significant correlation between ESAK and PKA values and correlation coefficients, ranging from 0.77 to 1 with P-value < 0.001 in most studies. This method can be employed by incorporating dose data and related parameters into the X-ray device's software, similar to other dose-displayed information. The online determination of ESAK from PKA could help with quality assurance and patient dose management in digital radiology.

Physical and psychological workloads and their association with occupational fatigue among hospital service personnel

BackgroundPhysical and psychological workloads are a vital issue in the workplace. This study aimed to investigate the association between physical and psychological workloads and occupational fatigue among Iranian hospital service personnel. In Iran, hospital service personnel refers to a group of healthcare workers who undertake a range of duties, such as moving and carrying the hospital waste, transporting patients by wheelchair or gurney to the operating room, x-ray department, other wards, or other locations around the facility, performing cleaning tasks such as changing linens, mopping floors, and sterilizing equipment, and following infection control procedures to reduce the risk of spreading germs within the hospital setting.MethodsThis cross-sectional study was conducted on 198 Iranian hospital service personnel. The response rate was 86%. The data were gathered using 1) The Persian version of the Job Content Questionnaire (P-JCQ) for assessing physical and psychosocial workloads and 2) The Persian version of the Swedish Occupational Fatigue Inventory (P-SOFI-20) for assessing fatigue dimensions.ResultsAccording to the P-JCQ, the physical and psychological workload intensities were high in 72.7% and 47% of the participants, respectively. Based on the P-SOFI, the participants’ mean scores of “physical fatigue” (21.73 ± 6.2), “psychological fatigue” (13.61 ± 5.76), and “fatigue due to shift work” (18.17 ± 5.6) were moderate, while the mean score of “general fatigue” was high (27.3 ± 6.98). The findings revealed that various types of fatigue are associated with age, gender, marital status, daily working hours, and psychological workload.ConclusionsPsychological workload was a determinant of occupational fatigue among Iranian hospital service personnel. Hence, an interventional program, including job enrichment, job rotation, and work-rest cycle, is recommended.

Real-World Visual Experience Alters Baseline Brain Activity in the Resting State: A Longitudinal Study Using Expertise Model of Radiologists.

Visual experience modulates the intensity of evoked brain activity in response to training-related stimuli. Spontaneous fluctuations in the restful brain actively encode previous learning experience. However, few studies have considered how real-world visual experience alters the level of baseline brain activity in the resting state. This study aimed to investigate how short-term real-world visual experience modulates baseline neuronal activity in the resting state using the amplitude of low-frequency (<0.08 Hz) fluctuation (ALFF) and a visual expertise model of radiologists, who possess fine-level visual discrimination skill of homogeneous stimuli. In detail, a group of intern radiologists (n = 32) were recruited. The resting-state fMRI data and the behavioral data regarding their level of visual expertise in radiology and face recognition were collected before and after 1 month of training in the X-ray department in a local hospital. A machine learning analytical method, i.e., support vector machine, was used to identify subtle changes in the level of baseline brain activity. Our method led to a superb classification accuracy of 86.7% between conditions. The brain regions with highest discriminative power were the bilateral cingulate gyrus, the left superior frontal gyrus, the bilateral precentral gyrus, the bilateral superior parietal lobule, and the bilateral precuneus. To the best of our knowledge, this study is the first to investigate baseline neurodynamic alterations in response to real-world visual experience using longitudinal experimental design. These results suggest that real-world visual experience alters the resting-state brain representation in multidimensional neurobehavioral components, which are closely interrelated with high-order cognitive and low-order visual factors, i.e., attention control, working memory, memory, and visual processing. We propose that our findings are likely to help foster new insights into the neural mechanisms of visual expertise.

Subjective symptoms of SMFs and RF energy, and risk perception among staff working with MR scanners within two public hospitals in South Africa

ABSTRACT This study assessed subjective symptoms associated with exposure to static magnetic fields (SMFs) and radiofrequency (RF) energy, and perceived safety risk of scanners among magnetic resonance (MR) staff working in the 1.5 and 3 T MRI units. A questionnaire survey was completed by 77 clinical imaging staff working in two hospitals (A and B) in the Mangaung metropolitan region. 50 participants working with the MR scanners were regarded as exposed group and 27 participants from CT scan and X-ray departments were classified as control group. The study comprised 57% females and 43% male participants with an average MRI experience of 5.4 years. Using logistic regression, tinnitus was significantly different between various job titles (p< .034) and it was reported more often (OR 8:00; CI 1.51, 15.17) by those who worked on a 3 T scanner. Increased years of MRI experience was a significant predictor of headache (p< .05), and reporting of nausea was significantly different between various job titles (p < .01). There was an increased risks of reporting vertigo often among female participants (OR: 4.43; CI 0.91, 21.47), those with 5–15 years of MRI experience (OR: 2.09; CI 0.47, 9.34), and those with a light to moderate workload (OR: 2.70; CI 0.49, 14.86). Using linear regression, presence in zone IV during image acquisitioning was the only significant predictor for the sensation of glowing (p < .000). Movement of head/ upper body in the scanner bore was a significant predictor of nausea (p< .026), vertigo (p< .014), instability when standing (p< .014), and a metallic taste (p< .031). There was no correlation between reporting of symptoms and perceived risk of scanners. However, shift duration (rs = 0.576), movement of head/upper body in the scanner bore (rs = 0.424), and strength of the scanners (rs = 0.299) were significantly correlated with perceived risk of scanners. MRI safety training and a comprehensive occupational health and safety program are necessary.

Results of clinical application of the color contrasting method of digitalx-rays

Introduction. Color processing of X-ray images has a long history and initially was directed for improvement of analysis of medical diagnostic images. Purpose — to evaluate the results of clinical application of the method for color contrast enhancement of digital radiographs.Material and methods. The study was carried out in the X-ray department of the city Mariinsky hospital in St. Petersburg, having installed a computer program on the workstations of the radiologists for carrying out color contrasting of digital radiographs (CCDR). The CCDR program allowed the radiologist to select one of 63 trajectories in 8 colors. Choosing options for coloring, we settled on a warm, cold, full scale, as well as 4 combinations of one color from cold and warm scales with a saturation from 0 to 100%. The CCDR performed 100 digital radiographs of various anatomical areas.We analyzed a variety of colors and their percentage of saturation in terms of optimal transmission of pathological signs of anatomical areas. 27 radiologists assessed the possibilities of CCDR in X-ray diagnostics.Results. Clinical application of CCDR showed that thanks to this method, tissues of different densities were distinguished in more detail on the X-ray image, since their contours were more expressively emphasized. Pathological symptoms, indistinctly expressed on a black-and-white radiograph, were convincingly reflected in the colorized image, which increased the sensitivity and specificity of the diagnosis. Thanks to color post-processing, it was possible to optimize subtle radiological signs of structural bone changes, traumatic injuries of the ribs, impaired pneumatization of the lungs (infiltration, hypoventilation), pneumo-, hydrothorax, and others. Of the radiologists, 77% considered it important to use CCDR in X-ray diagnostics.Conclusion. A digital radiograph, contrasted with a color of optimal saturation, has distinct advantages over a traditional blackand-white X-ray image, since it reveals hidden or subtle diagnostic information. The diagnostic efficiency of the method of color contrasting of radiographs is higher than the analysis of black-and-white images up to 13%.To increase the diagnostic capabilities of X-ray diagnostics, it is advisable to include the method of color contrasting in the package of computer post-processing of images, using at least three gamuts in the standard, the saturation of which is 25–50%.The colorized image does not replace black and white, but complements it, resolving the diagnostic doubts of the radiologist.

Biochemical Study on the Impact of Radiation-induced Oxidative Stress on Radiographers in the X-ray and CT-scan Departments

تم تحليل عواقب الإجهاد التأكسدي المتأين الناجم عن الإشعاع على مصوري الأشعة في أقسام الأشعة السينية والتصوير المقطعي باستخدام العديد من فحوصات الكيمياء الحيوية. وجدت الدراسة تناقضات كبيرة ملحوظة في التفاعل بين مستويات الأشعاع والجنس من حيث متوسط مالونديالديهيد ( MAD) ، فيتامين (D3) ، ثلاثي يودوثيرونين (T3) ، هرمون ثايروكسين (T4) و بروتين الدهني عالي الكثافة (HDL) ، و لكن ليس على هرمون الغدة الدرقية ( TSH) والكوليسترول و الدهون الثلاثية ( TG) والبروتين الدهني منخفض الكثافة( LDL). تشير النتائج الى ان مالونديالديهيد هو علامة حيوية مفيدة لتقييم الإجهاد التأكسدي في التصوير الشعاعي مع التعرض للإشعاع المؤين.

Radiology department of the Central Research Institute of Dentistry and Maxillofacial Surgery: stages of research work

The stages of the 60-year period of scientific research in the X-ray department of Central Research Institute of Dentistry and Maxillofacial Surgery. The research work was carried out in parallel with the improvement of X-ray diagnostics in dentistry and maxillofacial surgery based on the use of modern specialized X-ray equipment: panoramic radiography of the jaws, linear and panoramic zonography of the maxillofacial region, CT and CBCT of facial bones. For many decades, the department has been developing methodological and organizational foundations for X-ray examination of patients, conducted a comparative assessment of the informative value of X-ray techniques, studied the radiographic features of inflammatory, traumatic, tumor, tumor-like, congenital, post-traumatic and systemic pathological processes in the dental system and maxillofacial region.

Treatment of a newborn with birth trauma of the liver with catheter embolization of a vessel

Birth trauma of the liver with the development of subcapsular hematoma and hemoperitoneum is reported extremely rarely. The slow enlargement of the hematoma also results in delayed development of bleeding symptoms. Noticeable clinical manifestations appear simultaneously when the hematoma ruptures into the abdominal cavity. Later, the symptoms develop very quickly that doctors failed to understand the root cause of the bleeding. The diagnosis is established only during autopsy. When conservative therapy is ineffective, open surgery is conducted; however, the surgery is associated with a high risk of unfavorable outcomes. Herein, we present a clinical case demonstrating successful treatment with endovascular embolization of a vessel due to bleeding from a giant subcapsular hematoma of the liver in a newborn.&#x0D; The child was born in a settlement of the Arkhangelsk Region and weighed 3480 grams. A vacuum extractor was used to assist the weak mother during delivery. The child was in a critical condition and suffered from asphyxia. Mechanical ventilation was used. At 10 h after birth, the child was taken to a specialized neonatal center of Arkhangelsk (the helicopter flight took 2.5 h). The intensive therapy continued. Negative dynamics followed. At 25 h after birth, hemodynamic indexes decreased. X-ray and ultrasound investigations of the abdominal cavity revealed a large hematoma in the liver. It occupied the entire area of the right liver lobe. Abdominal bleeding was diagnosed. The child was taken to the X-ray department. The newborn underwent urgent endovascular embolization of the right hepatic artery. The bleeding was stopped, and the childs condition was stable. On follow-up at age 1 year and 5 months, the childs development was in accordance with age, and blood biochemical parameters were within normal limits. Ultrasound data revealed well recovery of the liver structure.&#x0D; With extensive birth trauma of the liver, minimally invasive surgery, i.e., endovascular embolization of vessels, can be considered an alternative option to surgical treatment.

159 The Need Of Six Monthly Follow Up X-Rays Post Total Knee Replacement(TKR)

Abstract Background There is a longstanding culture of repeat x-rays after total knee replacement (TKR) as part of follow up, often combined with a clinic review. This is to check that the prosthesis is in a satisfactory position. There are inherently a number of issues with this historic approach including exposure of patients to further radiation who may be asymptomatic, time delays in busy clinics or x-ray departments and costs. Objectives The aim of this audit was to assess whether follow up plain films after TKR are methodically undertaken and of benefit to confirm satisfactory appearance if immediate post -operative x-rays were unremarkable. The findings of a six month follow up x-ray was specifically evaluated. The secondary aim was to establish the timing of further follow up x-rays within the department. Method 200 patients were included within the analysis, they all received a TKR at a major trauma centre, over a one-year period between December 2017 and December 2018. Results It was found that 100% of those patients having a post-operative film had a satisfactory appearance. 78% of patients had at least one further follow op x-ray of which 99.4% were satisfactory. Up to five follow up x-rays were taken with 53.5% of patients having a follow up x-ray at 6 months. Conclusions From the above results there is minimal, if any, evidence within the data set to support routine, additional follow up imaging if initial post-operative films are satisfactory, and the patient is asymptomatic.