X-ray Generator Research Articles

The Implementation of MuDirac in Geant4: A Preliminary Approach to the Improvement of the Simulation of the Muonic Atom Cascade Process

Muonic Atom X-ray Emission spectroscopy (µ-XES) is a novel elemental technique that exploits the high-energy X-rays emitted from the muonic atom cascade process to characterize materials. At the ISIS Neutron and Muon Source, the technique is performed at Port4 of the RIKEN-RAL facility, with a user demand that is increasing every year. To cope with this demand, it is necessary to continue to improve the method, either for the hardware (detectors, acquisition, etc.) or software (data analysis and interpretation). In both cases, Monte Carlo codes play an important role: with a simulation, it is possible to reproduce the experimental setup and provide a reliable quantitative analysis. In this work, we investigate the capabilities of GEANT4 for such applications. From the results, we observed that the generation of X-rays, especially the kα and kβ transition for high Z atoms, are not in agreement with the experimental ones. A solution to this issue, other than an attempt with a small modification of the GEANT4 cascade class, could be provided by a database of transition energy calculated by a Dirac equation software called MuDirac. The software, developed by the UKRI scientific computing department and the ISIS muon group, can compute all the transition energy for a given nuclide. Here, preliminary results of the implementation of the MuDirac database in GEANT4 are reported.

Use of Vacuum to Increase the Effectiveness of X-Ray Tube Maintenance

Each device requires redundancy, including the X-ray machine. In an X-ray machine, there is an important component as the location for the creation of X-rays, namely the X-ray tube. This tube needs routine maintenance to increase the tube's lifetime. In addition, maintenance that was originally done manually, with this device can be done automatically and more quickly. In addition, maintenance that was originally done manually can be done automatically and faster with this device. X-ray tube oil vacuum is used as an effective solution for the maintenance of an X-ray tube machine that lasts for days. This device comes with easy use, equipped with two buttons and a display. This device can increase the productivity of both the device and the technician itself. The application of the use of X-ray tube oil vacuum is intended for hospitals and health facilities that have active X-ray machines. This device has been able to be built. Based on the results, it has a 2.5% error for the measurement at minimum and maximum pressure and a 3% error at -15 KPa pressure. The volume of the X-ray tube fully filled is always the same for each measurement. It can be concluded that this device can be effective in time because it only takes minutes to fill the X-ray tube up to full. Still, many parts can be improved and developed, such as the size and the weight.

Role of emergency teleradiology in a mass motorcycle event: the experience of the 2021 International Six Days of Enduro (ISDE).

Provision of healthcare support at mass gathering sporting events is of paramount importance for the success of the event. Many of such events, like motorsports, have been increasingly taking place in remote and austere environments. In these settings, the use of first-line diagnostic tools, such as point of care ultrasound and portable X-ray, could aid in definitive care on the field for patients with minor trauma while also ensuring fast access to the appropriate level of care for patients requiring hospitalization. As part of the ISDE 2021 medical response plan, a field hospital equipped with portable digital X-ray and telemedicine was established. Data on patient admission, triage, treatments, diagnostics, and outcomes were collected for analysis. During the 6-day competition, 79 patients sought medical care at the field hospital, with traumatic injuries accounting for 77% of cases. Of these, 47 were athletes and 32 were non-athletes. The majority (91%) arrived spontaneously, while 9% were transported directly. Upon admission, 68 patients were triaged as non-urgent (code 3) and 11 as urgent (code 2). Of those admitted, 69 received treatment and were discharged at the field hospital, while 10 were transferred elsewhere. Notably, four patients had major trauma, two had isolated fractures, and one needed a CT scan after losing consciousness. Overall, 29 missions were conducted on the race field, including 13 primary transports to local hospitals and 6 to the field hospital. Primary transport was primarily due to major trauma. Among 31 patients who had radiological exams, 11 (35.5%) had traumatic injuries. Of these, 5 were treated with braces and casts and discharged without hospitalization, 3 were advised for post-event care, and 3 were hospitalized. In contrast, patients with negative X-rays received on-site treatment, with 7 able to continue competing. In summary, the successful implementation of portable X-ray machines and teleradiology at remote and austere high-risk sporting events holds great promise for enhancing on-site medical capabilities, allowing clinicians informed decisions, avoiding unnecessary hospitalization, and allowing athletes to continue with their competition. Provided that challenges related to cost, safety, connectivity, and power supply are effectively addressed.

Pulmonary abnormality screening on chest x-rays from different machine specifications: a generalized AI-based image manipulation pipeline

BackgroundChest x-ray is commonly used for pulmonary abnormality screening. However, since the image characteristics of x-rays highly depend on the machine specifications, an artificial intelligence (AI) model developed for specific equipment usually fails when clinically applied to various machines. To overcome this problem, we propose an image manipulation pipeline.MethodsA total of 15,010 chest x-rays from systems with different generators/detectors were retrospectively collected from five institutions from May 2020 to February 2021. We developed an AI model to classify pulmonary abnormalities using x-rays from a single system. Then, we externally tested its performance on chest x-rays from various machine specifications. We compared the area under the receiver operating characteristics curve (AUC) of AI models developed using conventional image processing pipelines (histogram equalization [HE], contrast-limited histogram equalization [CLAHE], and unsharp masking [UM] with common data augmentations) with that of the proposed manipulation pipeline (XM-pipeline).ResultsThe XM-pipeline model showed the highest performance for all the datasets of different machine specifications, such as chest x-rays acquired from a computed radiography system (n = 356, AUC 0.944 for XM-pipeline versus 0.917 for HE, 0.705 for CLAHE, 0.544 for UM, ple 0.001, for all) and from a mobile x-ray generator (n = 204, AUC 0.949 for XM-pipeline versus 0.933 for HE, p = 0.042, 0.932 for CLAHE (p = 0.009), 0.925 for UM (p = 0.001).ConclusionsApplying the XM-pipeline to AI training increased the diagnostic performance of the AI model on the chest x-rays of different machine configurations.Relevance statementThe proposed training pipeline would successfully promote a wide application of the AI model for abnormality screening when chest x-rays are acquired using various x-ray machines.Key points• AI models developed using x-rays of a specific machine suffer from generalization.• We proposed a new image processing pipeline to address the generalization problem.• AI models were tested using multicenter external x-ray datasets of various machines.• AI with our pipeline achieved the highest diagnostic performance than conventional methods.Graphical

THE INFLUENCE OF FLIGHT SAFETY FACILITIES AGAINST SECURITY IN THE CARGO TERMINAL MINANGKABAU INTERNATIONAL AIRPORT

Minangkabau International Airport is an airport located in Padang Pariaman, West Sumatra (ICAO Code : WIEE ; IATA Code : PDG), has a Domestic Terminal, VIP Terminal, International Terminal, and Cargo Terminal. At the cargo terminal, problems were found that arose due to a lack of security facilities and personnel. So we need a study that can provide an explanation regarding aviation security facilities at the Minangkabau International Airport Cargo Terminal. The purpose of this study was to determine the effect of aviation security facilities on security at the cargo terminal capable of providing security for goods and cargo. The type of this research is descriptive quantitative using data obtained from observations, distributing questionnaires, and literature studies. Respondents from the questionnaire were Aviation Security and Angkasa Pura Cargo personnel, with a total sample of 61 people. The results of the discussion, there is an influence of variable X (aviation security facilities) on Y (security at the cargo terminal) has a relationship or correlation between variables with 0.78 (high, strong correlation) and the R square value is 0.608 or 60.8 % . There are things that need to be optimized in terms of the influence of aviation security facilities on security at the Minangkabau International Airport Cargo Terminal, the need to increase the number of Aviation Security personnel licensed by Junior Avsec to operate 1 x-ray machine with a minimum of 3 people and the need for security facilities is not yet adequate, such as the absence of a Walk Through Metal Detector.

Study of the length of the anterior base of the skull in children from the Moscow region

Relevance. One of the starting points for calculating the parameters of growth and the ratio of the jaws is considered to be the sagittal size of the anterior base of the skull. To this day, many orthodontists are guided by the average values of the anterior skull base, found in 1972. This article is devoted to the study of the comparison of the average statistical sagittal dimensions of the length of the anterior skull base in children of the Moscow region aged 4 to 16 years with occlusal ratios according to the first Angle class in 2023 with the data proposed in the studies of Dr. Jarabak in 1972.Objective. To compare the average sagittal dimensions of the length of the anterior base of the skull in children of the Moscow region aged from 4 to 16 years with occlusal ratios for the first Engl class in 2023 with the data proposed in the studies of Dr. Jarabak in 1972.Materials and methods. The study included 331 people aged 4 to 16 years. The sagittal dimensions of the length of the anterior base of the skull were calculated in the digital program for the analysis of CBCT in children with occlusive ratios in the first class of male and female Engl on the digital X-ray machine Planmeca ProMax 3D Max X-ray diagnostic centers «Golden Section».Results. Male patients of the Moscow region approach the lower limits of the growth value of the anterior base of the skull only by the age of 12 and reach the confident values of the norm proposed by Dr. Jarabak only by the age of 16. And female patients in the Moscow region, for the most part, do not reach the limits of the norm proposed by Dr. Jarabak, lagging in values by 2–3 mm in a smaller direction.Conclusion. It is necessary to calculate and develop norms for Russian children, taking into account racial characteristics, environmental conditions, nutritional conditions, physical and social development, which differ significantly, but at the same time strongly affect the growth and formation of skeletal structures.

ZNAČAJ KLASIČNE RADIOGRAFIJE PLUĆA U OTKRIVANJU TUBERKULOZE PLUĆA

ABSTRACT
 
 Diagnostic radiology provides a non-invasive insight into the anatomy and physiology of the human body and is one of the most useful tools in modern medicine. Accelerated technological development has led to improved image quality and the ability to obtain additional diagnostic information necessary for accurate and rapid diagnostics. As in other fields of medicine, in diagnostic radiology, all elements of risk must be balanced against the benefits arising from the use of a given diagnostic method.
 Aim: study is to determine the age and gender structure of the subjects who came for radiographs, to prove whether the X-ray has a significant role in detecting lung tuberculosis, whether the radiological record matches the findings of a pneumophysiologist or whether a microbiological analysis is needed, and to determine whether tuberculosis detected by classical radiography is also proven.
 Prospective method included 50 adult respondents from the Public Health Center of the Canton of Sarajevo, of different age and gender structures, who performed radiographic pulmonary imaging and processing of pneumophysiological findings in the period from 01.01.2018. do 30.05.2019. years. X-rays were taken from the classic Siemens Multix X-ray machine. Patients' medical records, microbiological examination of sputum on BC, pneumophysiological findings, radiographs and radiological findings from the radiological information system and the PACS system were used for the data. We used a retrospective study that included descriptive statistics, standard deviation, arithmetic mean, and correlation coefficient.
 Results: show that there is no significant statistical difference by gender, the average age of the respondents was 50, 52 years. 
 X-ray imaging as a diagnostic procedure is of great importance in the detection of pulmonary tuberculosis, and 72% of the subjects had pulmonary tuberculosis first compared with the findings of pneumophysiologists, and bacteriological analysis was used in 28% subjects due to suspected pneumophysiologists in the diagnosis. By comparing the correlation of the pneumophysiologist and the bacteriological analysis, the X-ray showed 100% lung tuberculosis.

A Panoramic X-ray as a Supportive Diagnostic Tool for the Screening of Osteoporosis in Patients with Hemophilia A and B.

Hemophilia is associated with an increased risk of developing osteoporosis and osteopenia. The aim of the study was to interpret the usefulness of fractal analysis of the trabecular bone of the mandible (FD) and selected radiomorphic indices (the antegonial index (AI) and Klemetti index (KI)) to assess the risk of reduced bone mineral density (BMD) in patients with hemophilia A/B. The study group consisted of 50 patients with type A/B hemophilia. The control group consisted of 25 males without congenital bleeding disorders. The patients had a panoramic radiograph taken with the same X-ray machine (Vistapano S, Durr Dental, Bietigheim-Bissingen, Germany). The AudaXCeph software (Audax d.o.o., Ljubljana, Slovenia) was used to evaluate the AI index, and the ImageJ, software with a specially prepared script, was used to evaluate the FD. The mandibular cortex was assessed distal to the mental foramen using the Klemetti index. There were no statistically significant differences between the AI, KI and FD values between the study group and the control group. This study indicated the lack of usefulness of AI, KI and fractal analysis in identifying patients with hemophilia at risk of reduced bone mass.

Absolute calibration of the spectral sensitivity of an x-ray streak camera over the 0.1-10keV spectral range equipped with CsI photocathode.

In this paper, we report the absolute measurement of the spectral sensitivity of a bilamellar tube x-ray streak camera (XRSC) over the 0.1-10keV range equipped with a CsI photocathode for Laser MégaJoule (LMJ) fusion experiments. This calibration of the XRSC is performed in static mode by using two multi-anode x-ray generators. Two silicon drift detectors (SDDs) previously calibrated at the Physikalisch-Technische-Bundesanstalt radiometric laboratory are used as secondary standards. Both x-ray generators work with a specific monochromator for radiometric measurements. In the sub-keV region, a 1 m-grazing incidence Rowland geometry monochromator specifically developed to handle LMJ's x-ray camera is used, whereas for higher energies (>2keV), a double-crystal monochromator is employed. The absolute spectral sensitivity of the XRSC is obtained by comparing the CCD counts of the XRSC output with the output counts in x-ray lines recorded by the SDD. The results obtained below 1.2keV are, to our knowledge, the first measurements of the spectral sensitivity of an XRSC in the soft x-ray range with a CsI photocathode. Comparison with a model describing the spectral dependence of the sensitivity of the XRSC revealed that measurements obtained in the sub-keV region are greater than expected, whereas they agree with the model above 4.5keV. There may be several contributors to this behavior, including the grain morphology of the CsI layer and exposure to air.

Screening the phytotoxicity of micro/nanoplastics through non-targeted metallomics with synchrotron radiation X-ray fluorescence and deep learning: Taking micro/nano polyethylene terephthalate as an example

Microplastics (MPs) and nanoplastics (NPs) are global pollutants with emerging concerns. Methods to predict and screen their toxicity are crucial. Elemental dyshomeostasis can be used to assess toxicity of environmental pollutants. Non-targeted metallomics, combining synchrotron radiation X-ray fluorescence (SRXRF) and machine learning, has successfully differentiated cancer patients from healthy individuals. The whole idea of this work is to screen the phytotoxicity of nano polyethylene terephthalate (nPET) and micro polyethylene terephthalate (mPET) through non-targeted metallomics with SRXRF and deep learning algorithms. Firstly, Seed germination, seedling growth, photosynthetic changes, and antioxidant activity were used to evaluate the toxicity of mPET and nPET. It was showed that nPET, at 10 mg/L, was more toxic to rice seedlings, inhibiting growth and impairing chlorophyll content, MDA content, and SOD activity compared to mPET. Then, rice seedling leaves exposed to nPET or mPET was examined with SRXRF, and the SRXRF data was differentiated with deep learning algorithms. It was showed that the one-dimensional convolutional neural network (1D-CNN) model achieved 98.99% accuracy without data preprocessing in screening mPET and nPET exposure. In all, non-targeted metallomics with SRXRF and 1D-CNN can effectively screen the exposure and phytotoxicity of nPET/mPET and potentially other emerging pollutants. Further research is needed to assess the phytotoxicity of different types of MPs/NPs using non-targeted metallomics.

How efficient are metal-polymer and dual-metals-polymer non-lead radiation shields?

Lead shields are often used to attenuate ionising radiations. However, to make lighter, recyclable and more efficient shields compared to lead, combinations of new metallic compounds together with polymer, for example, flexible polyvinyl chloride (PVC) have been developed recently. In this study, the capabilities of non-lead radiation shields made of one or two metallic compounds and polymer were evaluated. Monte Carlo (MC)-based BEAMnrc code was used to build a functional model based on a Philips X-ray machine in the range of radiographic energies. The MC model was then verified by IPEM Report 78 as a standardised global reference. The MC model was then used to evaluate the efficiency of non-lead-based garments made of metallic compound and polymer (MCP) including BaSO4 -PVC, Bi2 O3 -PVC, Sn-PVC and W-PVC, as well as dual-metallic compounds and polymer (DMCP) including Bi2 O3 -BaSO4 -PVC, Bi2 O3 -Sn-PVC, W-Sn-PVC and W-BaSO4 -PVC. The absorbed doses were determined at the surface of a water phantom and compared directly with the doses obtained for 0.5 mm pure lead (Pb). Bi2 O3 -BaSO4 -PVC and W-BaSO4 -PVC were found to be efficient shields for most of the energies. In addition to the above radiation shields, Bi2 O3 -Sn-PVC was also found to be effective for the spectrum of 60 keV. Bi2 O3 -BaSO4 -PVC as a non-lead dual metals-PVC shield was shown to be more efficient than pure lead in diagnostic X-ray range. Combination of two metals-PVC, a low atomic number (Z) metal together with a high atomic number metal, and also single-metal-PVC shields were shown to be efficient enough to apply as radiation protection shields instead of lead-based garments.

Comparative Evaluation of the Relationship Between Airway Inadequacy, Head Posture, and Craniofacial Morphology in Mouth-Breathing and Nasal-Breathing Patients: A Cephalometric Observational Study.

The process of respiration is the primary factor of the posture of the jaws and tongue. Thus, a changed respiratory form like mouth breathing can change the posture of the head, jaw, and tongue. This, in turn, could change the equilibrium of pressure on the jaws and teeth thus affecting jaw growth and teeth positions. The influence of nasorespiratory function on craniofacial growth has stimulated interest and debate for more than a century. Mouth breathing is the reason for numerous orthodontic glitches such as a mouth breather's face evolving aberrantly because of of functional disruptions triggered by chronic airway obstruction. The relationship between nasorespiratory function and dentofacial development remains controversial despite the long-standing clinical concern of orthodontists, so there was a need to evaluate and compare the relationship between head posture, airway inadequacy, and craniofacial morphology in mouth breathers and nasal breathers. Forty patients were selected and divided equally into two groups: mouth breathers and nasal breathers. Patients were diagnosed as mouth breathers based on physical examination and a history of chronic allergic rhinitis, adenoid, and tonsil enlargement. Lateral cephalograms were taken for all patients in the natural head position (NHP) with the Planmeca Proline XC Dimax3 x-ray machine (Planmeca, Helsinki-Uusimaa, Finland). All lateral cephalograms were traced and analysis was done to check airway, head posture, and craniofacial morphology. Descriptive statistics were performed to obtain the means and standard deviation of all the sample sizes. Unpaired t test was performed between nasal breathers and mouth breathers to check and evaluate the relationship. Mouth-breathing patients varied from nasal-breathing patients in airway adequacy and craniofacial morphology. A little, but not statistically significant, difference was seen in head posture between the two groups. Early interception of mouth breathing in patients could be very helpful, as the postural changes in the mouth-breathing patients, if continued for a longer period of time, could be the reason for severe skeletal deformities as well as dental malocclusion.

Identifying Coronary Artery Calcification Using Chest X-ray Radiographs and Machine Learning: The Role of the Radiomics Score.

To evaluate the ability of radiomics score (RS)-based machine learning to identify moderate to severe coronary artery calcium (CAC) on chest x-ray radiographs (CXR). We included 559 patients who underwent a CAC scan with CXR obtained within 6 months and divided them into training (n = 391) and validation (n = 168) cohorts. We extracted radiomic features from annotated cardiac contours in the CXR images and developed an RS through feature selection with the least absolute shrinkage and selection operator regression in the training cohort. We evaluated the incremental value of the RS in predicting CAC scores when combined with basic clinical factor in the validation cohort. To predict a CAC score ≥100, we built an RS-based machine learning model using random forest; the input variables were age, sex, body mass index, and RS. The RS was the most prominent factor for the CAC score ≥100 predictions (odds ratio = 2.33; 95% confidence interval: 1.62-3.44; P < 0.001) compared with basic clinical factor. The machine learning model was tested in the validation cohort and showed an area under the receiver operating characteristic curve of 0.808 (95% confidence interval: 0.75-0.87) for a CAC score ≥100 predictions. The use of an RS-based machine learning model may have the potential as an imaging marker to screen patients with moderate to severe CAC scores before diagnostic imaging tests, and it may improve the pretest probability of detecting coronary artery disease in clinical practice.

Analysis of imaging equipments of human internal organs

Medical imaging is an important tool in the diagnosis and monitoring of diseases affecting human internal organs. This work presents a comprehensive analysis of the various medical imaging equipments used to visualize human internal organs, including conventional X-ray machines, computed tomography scanners, ultrasound, magnetic resonance imaging, and multispiral computed tomography. The article examines the advantages and functions of each of these equipments.

X-ray generation by fs-laser processing of biological material.

The use of ultrashort pulse lasers in medical treatments is increasing and is already an essential tool, particularly in the treatment of eyes, bones and skin. One of the main advantages of laser treatment is that it is fast and minimally invasive. Due to the interaction of ultrashort laser pulses with matter, X-rays can be generated during the laser ablation process. This is important not only for the safety of the patient, but also for the practitioner to ensure that the legally permissible dose is not exceeded. Although our results do not raise safety concerns for existing clinical applications, they might impact future developments at higher peak powers. In order to provide guidance to laser users in the medical field, this paper examines the X-ray emission spectra and dose of several biological materials and describes their dependence on the laser pulse energy.

Study of bremsstrahlung radiation coming from a transmission type x-ray generator and its application on EDXRF technique

We have demonstrated the use of the bremsstrahlung radiation from a small, portable, transmission type x-ray generator that can be used in energy dispersive x-ray fluorescence technique as a tool to perform non-destructive elemental analysis of solid samples employed in inter-disciplinary science research. As our knowledge goes, till date, this is the first attempt to generate the bremsstrahlung spectrum theoretically from a portable transmission type x-ray generator and compared it with the actual observation. Theoretically generated bremsstrahlung spectra are also found to be in good agreement with the experimentally observed spectra obtained with various operating anode voltages of the x-ray generator. A computer program has been developed utilizing a few atomic parameters to obtain the elemental concentrations in the sample by a single run using the whole bremsstrahlung. The knowledge of incoming x-ray flux, geometry of experimental arrangements are not required in this technique. To validate the technique, we have taken two samples: an Indian one rupee coin of the year 2000 and a NIST made brass sample, whose compositions are well known. We have used these samples to expose to the bremsstrahlung radiation, produced by the operating anode voltages 20, 25, and 30 KV. The relative concentrations of different elements are determined, which is in good agreement with the earlier results.

New opto-electro-mechanical sensor for two-dimensions dosimetry based on radiochromic films

This work presents the validation of a new Opto‒Electro-Mechanical (MOEM) system consisting of a matrix of photodetectors for two-dimensional dosimetry evaluation with radiochromic films. The proposed system is based on a 5 × 10 matrix of photodetectors controlled by both in-house electronic circuit and graphical user interface, which enables optical measurements directly. We present the first tests performed in an X-ray machine and 137Cs source with that array by using Gafchromic EBT3 films. We obtained similar results than with a standard method (e.g. flat-bed scanner). Results were compared with Monte Carlo simulations and very good agreement was found. Results show the feasibility of using this system for dose evaluations. To the best of our knowledge, this is the first MOEM sensor for radiotherapy. Further developments are ongoing to create an advanced 16 × 16 LDRs system covering 1.6 cm × 1.6 cm with a 1 mm of spatial resolution. We point to develop a portable dosimetry tool delivering dose maps in real time to improve the clinical application of radiochromic films.

Critical analysis of the existing approach to the calculation of radiation shielding in X-ray rooms

The paper demonstrates the limitations of the existing methodology for calculating the radiation shielding of X-ray rooms presented in SanPin 2.6.1.1192-03. It is shown that the algorithm for calculating the attenuation coefficient by the barrier does not take into account the features of the attenuation of different components of X-ray radiation: direct, scattered, and leakage radiation, which differ in the region of occurrence, intensity, energy spectrum, and other parameters. Instead, a single formula is used for all components, and the differences in their attenuation are taken into account by a parameter the values of which for different radiation components are in no way justified and are questionable. The calculation also does not take into account the distribution of the workload of X-ray machines by the tube voltage, the significant attenuation of direct X-ray radiation by additional structures necessary for image acquisition. The values of the radiation output of X-ray machines recommended for shielding design in SanPiN 2.6.1.1192-03 are 2–3 times overestimated in relation to the measured values. This leads to an unreasonable overestimation of the requirements for the thickness of radiation shielding in X-ray rooms and accordingly to suboptimal spending on healthcare. It is necessary to develop a new document to replace SanPiN 2.6.1.1192-03.

A Case of Broken Local Anesthetic Needle in the Pterygomandibular Space; Diagnostic Approaches and Surgical Management.

Needle fracture during dental local anesthetic injections is a rare but significant, potentially serious complication. Various approaches for the location and removal of broken needles have been described; however, there are several difficulties and concerns related to the potential complications and critical anatomic challenges peculiar to the head and neck region. In this case, we describe the diagnostic approaches utilized in locating a broken needle that migrated in the pterygomandibular space following gag reflex, and sudden head movement of a middle-aged male patient. A meticulous diagnostic approach was employed to locate the needle utilizing CBCT scan, CT scan with contrast, and C-arm X-ray machine. The needle was successfully retrieved using an angled hemostat inserted through an oral incision, guided by a C-arm X-ray machine and ENT endoscopic instruments. While careful planning could prevent many complications that may arise during oral surgical procedures, inadvertent events leading to serious complications should be addressed using the appropriate and timely diagnostic techniques pre-and intra-operatively.

Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures

The objective was to compare the clinical efficacy of percutaneous pedicle screw internal fixation with the aid of the TINAVI orthopaedic surgery robot with that of traditional open surgery for Levine–Edward type IIA (postreduction) hangman fractures and to evaluate the safety and efficacy of the TINAVI robot-assisted orthopaedic surgery procedure. The clinical data of 60 patients with Levine–Edward type IIA (postreduction) hangman fractures treated surgically from June 2015 to February 2022 were analysed retrospectively. Among these patients, 25 were treated with percutaneous pedicle screw fixation under TINAVI (the robot group), and 35 were treated with pedicle screw implantation assisted by a conventional C-arm X-ray machine (the traditional operation group). The pedicle screw placement grade was evaluated according to the Rampersaud scale. The correct rate of pedicle screw placement was calculated. The invasion of adjacent facet joints, VAS score (Visual Analogue Scale), NDI score (Neck Disability Index), SF-36 score (36-Item Short-Form Health Survey questionnaire), EQ-5D score (EuroQol-5 dimensions questionnaire) and operation-related data were recorded, and patients were followed up. All patients were followed up for an average of 15.0 ± 3.4 months. The accuracy of screw placement in the robot group was higher than that in the traditional operation group, while the rates of intraoperative blood loss and invasion of the facet joint were lower and the incision length and length of hospital stay were shorter. On the 3rd day after the operation, the VAS score in the robot group was significantly higher than that in the traditional operation group, but there was no significant difference in the NDI score. On the 3rd day after the operation, the SF-36 and EQ-5 questionnaire scores of the robot group were better than those of the traditional operation group. No complications occurred in any of the patients. Postoperative cervical X-ray showed that the cervical vertebra was stable, and there was no fracture, angle or displacement. Postoperative CT showed that all fractures healed, and the average healing time was 3.4 months. The treatment of Levine–Edward IIA (postrepositioning) hangman fractures with percutaneous pedicle fixation assisted by the TINAVI orthopaedic surgery robot can significantly improve screw placement accuracy with a low rate of invasion of the adjacent facet joint, a short operation time, a low bleeding rate, and high patient satisfaction. Although there are still many disadvantages, it still has good prospects for application.