Hand X-ray Research Articles

Hand Joint Position Analysis System for the Care of Patients with Rheumatoid Arthritis

According to the studies carried out in advance, the medical area has analysed the patient's condition visually by applying a common methodology to all patients based on their knowledge of the disease, making a mistaken assessment due to the complexity of the disease, which varies according to the length of time the patient has been suffering from it. The problem posed by this disease rheumatoid arthritis is the bad evaluation by means of radiographs of the hands, relying on the criteria of the doctor when treating the disease with his experience, making serious mistakes when the quality of the image is not correct when interpreting a first stage disease with an advanced one, therefore, it is important to evaluate rheumatoid arthritis by means of an image treatment in a safe way for a better diagnosis of the patient. The aim of this research is to develop a hand joint position analysis system for the care of patients with rheumatoid arthritis to help doctors detect tuberculosis earlier and more accurately and to avoid prolonged infections that could be fatal for patients. The methodology used for this research is based on taking a computerized X-ray of both hands and applying image processing using a computer, the image processing is carried out using MATLAB by applying the various processing tools to detect these conditions. According to the tests performed, it was observed that the system detects the state of the patient with rheumatoid arthritis with an efficiency of 96.14% in its operation, standing out satisfactorily with respect to other systems for its high efficiency of image analysis of patients with the MATLAB tool. It concludes that this system can be used in different circumstances of the patient's condition, from the initial stage of arthritis to an advanced stage of the patient's disease.

Clinical significance of anti-mutated citrullinated vimentin antibodies in rheumatoid arthritis patients.

Anti-mutated citrullinated vimentin (MCV) antibodies have recently been recommended as a better arthritis diagnostic marker. To investigate the association between anti-MCV antibodies and the clinical, functional, and radiographic characteristics of rheumatoid arthritis (RA) patients. This case-control study was conducted on 40RApatients and 40healthy subjects. All patients were subjected to an assessment of disease using the 28-joint DAS (DAS28) and Clinical Disease Activity Index (CDAI), function by HAQ-DI, physical activity by International Physical Activity Questionnaire (IPAQ), fatigue by Functional Assessment of Chronic Illness Therapy (FACIT), serological tests as well as anti-MCV Abs measurement. A plain X-ray of both hands and wrists was done. The anti-MCV Abs level was significantly higher in RA patients than in healthy controls (P< 0.001). The anti-MCV Abs had a significant positive correlation with DAS, CDAI, HAQ, RF, Anti-CCP, and CRP (P= 0.006, 0.013, 0.005, < 0.001, < 0.001and 0.041respectively) and a significant negative correlation with FACIT (p= 0.007). Positive anti-MCV RA patients had significantly higher erosions, JSN, and a total sharp score. Anti-MCV Abs may contribute to poor physical activity and more fatigue in RA patients beyond their established role in disease activity and erosion.

A Deep Learning Approach to Detect Rheumatoid Arthritis Using Medical Images and Blood Samples

Rheumatoid arthritis (RA) is a long-term autoimmune disease that mainly affects the joints. It happens when the immune system, which should aid in defending the body against illness and infection, unintentionally targets healthy tissues. This may result in joint pain, edema, stiffness, and loss of function. RA postures are a noteworthy clinical challenge due to their inveterate nature and potential for joint deformation and systemic complications. Conventional demonstrative strategies frequently drop briefly in giving exact and opportune discovery, requiring imaginative approaches. In this way of thinking, the developed novel system coordinates profound learning strategies with multi-modal information, counting blood biomarkers and restorative pictures of influenced joints of the hand, to revolutionize RA discovery and seriousness assessment. By leveraging a comprehensive dataset and considering indication length, the proposed approach outperforms the confinements of existing strategies, advertising prevalent symptomatic precision and early discovery capabilities. Through fastidious assessment, the system illustrates the diminishment of wrong positives and untrue negatives, hence progressing persistent results and diminishing long-term joint damage. Furthermore, this novel system contributes to progressing the understanding of RA pathophysiology and treatment viability by cultivating logical advances through the development of a comprehensive dataset. As part of the multi-modal framework integration process, the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria are taken into account, and the system is improved by drawing on existing systems or discovered techniques. Specifically, the investigation was done on automating RA seriousness assessment using Profound Learning computations associated with hand X-ray pictures. Notwithstanding these advances, difficulties persist in accurately identifying early indications of RA from common variations or other joint disorders, as well as in identifying subtle joint deviations from the norm. To improve demonstration accuracy and advance in the comprehension of care outcomes in Rheumatoid Joint pain determination and severity evaluation, machine learning methodologies and multi-modal information integration were used.

Ensemble detection of hand joint ankylosis and subluxation in radiographic images using deep neural networks

The modified total Sharp score (mTSS) is often used as an evaluation index for joint destruction caused by rheumatoid arthritis. In this study, special findings (ankylosis, subluxation, and dislocation) are detected to estimate the efficacy of mTSS by using deep neural networks (DNNs). The proposed method detects and classifies finger joint regions using an ensemble mechanism. This integrates multiple DNN detection models, specifically single shot multibox detectors, using different training data for each special finding. For the learning phase, we prepared a total of 260 hand X-ray images, in which proximal interphalangeal (PIP) and metacarpophalangeal (MP) joints were annotated with mTSS by skilled rheumatologists and radiologists. We evaluated our model using five-fold cross-validation. The proposed model produced a higher detection accuracy, recall, precision, specificity, F-value, and intersection over union than individual detection models for both ankylosis and subluxation detection, with a detection rate above 99.8% for the MP and PIP joint regions. Our future research will aim at the development of an automatic diagnosis system that uses the proposed mTSS model to estimate the erosion and joint space narrowing score.

An Investigation On The Effect Of Smartphone Use On Morphological And Radiological Changes Of The Fifth Finger

Background: The purpose of this study is to describe the macroscopic and radiological changes on the fifth finger related to mobile phone use and to evaluate the effect of size and weight of the device and the average time spent using the smartphone on these morphological alterations. Methods: One-hundred and one patient were included in the study. Age, weight, height, education, mobile phone data and digital photographs used in this cross-sectional study were obtained from interviews with the participants in an outpatient orthopedics clinic setting. Digital photographs of the dorsal aspects of both hands were taken with an iPhone X ® (dual 12-megapixel wide camera). The DIP joint angle of the fifth finger was measured on computer software (Image J® version 1.46, National Institute of Health, Bethesda, MD) separately for digital photographs and AP hand X-rays. Results: The proportion of smartphone usage time over 4 hours was significantly higher in patients with complaints than patients without complaints (p&amp;lt;0.05). The mean time of smartphone use over 4 hours was significantly higher in patients with shape discrepancy than in patients without shape discrepancy (p&amp;lt;0.05). Conclusion: Smartphone use of more than 4 hours per day, regardless of size and weight, can cause deformity of the fifth finger, which may disturb the patient even if it does not cause radiologically changes.

The automated Greulich and Pyle: a coming-of-age for segmental methods?

The well-known Greulich and Pyle (GP) method of bone age assessment (BAA) relies on comparing a hand X-ray against templates of discrete maturity classes collected in an atlas. Automated methods have recently shown great success with BAA, especially using deep learning. In this perspective, we first review the success and limitations of various automated BAA methods. We then offer a novel hypothesis: When networks predict bone age that is not aligned with a GP reference class, it is not simply statistical error (although there is that as well); they are picking up nuances in the hand X-ray that lie "outside that class." In other words, trained networks predict distributions around classes. This raises a natural question: How can we further understand the reasons for a prediction to deviate from the nominal class age? We claim that segmental aging, that is, ratings based on characteristic bone groups can be used to qualify predictions. This so-called segmental GP method has excellent properties: It can not only help identify differential maturity in the hand but also provide a systematic way to extend the use of the current GP atlas to various other populations.

The effect of Providence night-time bracing on the sagittal profile in adolescent idiopathic scoliosis

PurposeAdolescent idiopathic scoliosis (AIS) is characterized by coronal scoliosis and often a sagittal hypokyphosis. The effect of bracing on the sagittal profile is not well understood. The aim of this study is to assess the effect of night-time bracing on the sagittal profile in patients with AIS.MethodsWe retrospectively included AIS patients with a main curve of 25–45° treated with a night-time brace in our institution between 2005 and 2018. Patients with estimated growth potential based on either Risser stage, hand X-rays, or menarchal status were included. Coronal and sagittal radiographic parameters were recorded at both brace- initiation and -termination. Patients were followed until surgery or one year after brace termination. Results were compared to a published cohort of full-time braced patients.ResultsOne hundred forty-six patients were included. Maximum thoracic kyphosis (TK) increased 2.5° (± 9.7) (p = 0.003), corresponding to a 3.5-fold relative risk increase post bracing in TK compared to a full-time brace cohort. Twenty-seven percent (n = 36) of the patients were hypokyphotic (T4/T12 < 20°) at brace initiation compared with 19% (n = 26) at brace termination (p = 0.134). All other sagittal parameters remained the same at follow-up. We found no association between progression in the coronal plane and change in sagittal parameters.ConclusionThis is the first study to indicate that night-time bracing of AIS does not induce hypokyphosis. We found a small increase in TK, with a substantially lower risk of developing flat back deformity compared to full-time bracing. The coronal curve progression was not coupled to a change in TK.

Standardization of Weightage Assigned to Different Segments of the Hand X-ray for Assessment of Bone Age by the Greulich-Pyle Method.

Bone age (BA) assessment is important in evaluating disorders of growth and puberty; the Greulich and Pyle atlas method (GP) is most used. We aimed to determine the weightage to be attributed by raters to various segments of the hand x-ray, namely, distal end of radius-ulna (RU), carpals, and short bones for rating bone age using the GP atlas method. 692 deidentified x-rays from a previous study (PUNE-dataset) and 400 from the Radiological Society of North America (RSNA-dataset) were included in the study. Mean of BA assessed by experienced raters was termed reference rating. Linear regression was used to model reference age as function of age ratings of the three segments. The root-mean-square-error (RMSE) of segmental arithmetic mean and weighted mean with respect to reference rating were computed for both datasets. Short bones were assigned the highest weightage. Carpals were assigned higher weightage in pre-pubertal PUNE participants as compared to RSNA, vice-versa in RU segment of post-pubertal participants. The RMSE of weighted mean ratings was significantly lower than for the arithmetic mean in the PUNE dataset. We thus determined weightage to be attributed by raters to segments of the hand x-ray for assessment of bone age by the GP method.

Bone age assessment based on three-dimensional ultrasound and artificial intelligence compared with paediatrician-read radiographic bone age: protocol for a prospective, diagnostic accuracy study

IntroductionRadiographic bone age (BA) assessment is widely used to evaluate children’s growth disorders and predict their future height. Moreover, children are more sensitive and vulnerable to X-ray radiation exposure than...

Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study

BackgroundLow bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related fragility fractures represent missed warning signs of more deadly, future fractures. This study aimed to determine if hand radiographs could serve as early, simple screening tools for predicting low forearm bone mineral density (BMD).MethodsWe evaluated posterior-anterior (PA) hand radiographs (x-rays) and Dual-energy X-ray absorptiometry (DXA) scans of 43 participants. The ratio of the intramedullary cavity to total cortical diameter of the second metacarpal (second metacarpal cortical percentage (2MCP)) was used as a potential diagnostic marker. Mixed-effects linear regression was performed to determine correlation of 2MCP with BMD from various anatomic regions. Repeated measures ANOVAs were used to compare BMD across sites. An optimal 2MCP cutoff for predicting forearm osteopenia and osteoporosis was found using Receiver Operating Curves.Results2MCP is directly correlated with BMD in the forearm. The optimal 2MCP of 48.3% had 80% sensitivity for detecting osteoporosis of the 1/3 distal forearm. An 2MCP cutoff of 50.8% had 84% sensitivity to detect osteoporosis of the most distal forearm. Both 2MCP cutoffs were more sensitive at predicting forearm osteoporosis than femoral neck T-scores.ConclusionsThese findings support the expansion of osteoporosis screening to include low-cost hand x-rays, aiming to increase diagnosis and treatment of low forearm BMD and fractures. Proposed next steps include confirming the optimal 2MCP cutoff at scale and integrating automatic 2MCP measurements into PAC systems.

The Application of Sesamoid Position in Diagnosing Thumb Metacarpophalangeal Joint Dorsal Dislocation: A Retrospective Study.

The position of sesamoid of thumb metacarpophalangeal (MCP) joint changed clearly when the joint was dislocated dorsally. However, the significance of sesamoid location in diagnosing joint dislocation was unclear. The present study aimed to explore the positional relationship between sesamoid bone and thumb metacarpophalangeal joint in normal and dorsal dislocation joints. Between January 2018 and August 2023, we collected 60 isometric plain films from sixty outpatients and reviewed 56 anisometric plain films from twenty-eight emergency patients with dorsal dislocation of thumb MCP joint at Tianjin Hospital, then took measurements on the hand X-ray images. The sesamoid length on its longitudinal axis was defined as DP, the distance between the distal edge of sesamoid and thumb MCP joint was defined as DJ, and the ratio of DJ and DP was R. An independent-samples t-test and paired-samples t-test was utilized to analyze difference among data groups. The 60 isometric images were from 30 male and 30 female outpatients with normal bone structure in their hands, and the 56 anisometric images of the 28 emergency patients included both preoperative and postoperative materials. Among the outpatients, the actual distance between the distal edge of sesamoid and thumb MCP joint space (DJ) was 2.09 mm and 1.40 mm in males and females, respectively. The authentic average length of sesamoid (DP) was 4.46 mm in males and 4.22 mm in females. The average value of R (the ratio of DJ and DP) in males and females was 0.49 and 0.34, respectively. There were gender-related statistical differences in DJ (p < 0.01) and R (p=0.01), but no statistical difference in DP (p > 0.05). For the 28 emergency patients, the mean value of R was -0.47 before joint reduction and 0.58 after joint reduction, with statistical difference between them (p < 0.01). There was significant difference in the relative position between sesamoid and thumb MCP joint when joint dislocation and joint reduction. The distal edge of sesamoid beyond thumb MCP joint could be an evidence in diagnosing joint dorsal dislocation. The distal edge of sesamoid below thumb MCP joint could be an evidence of joint reduction.

Phalangeal microgeodic syndrome: a paediatric case series.

We present the clinical and radiological characteristics of phalangeal microgeodic syndrome in a cluster of five children during the second peak of COVID-19 pandemic in the UK. Each child presented with phalangeal swelling and erythema, prompting a comprehensive multi-disciplinary team review to analyse the clinical presentation, blood test results and imaging. The cohort's average age was 14.1years, ranging from 10.4 to 16.6years, with two girls and three boys. Four children experienced phalangeal involvement in the hands, whilst one was affected solely in the feet. A rheumatological work-up was performed for all. Hand X-rays performed on three children revealed distinct radiographic features like microgeodes, subperiosteal bone resorption and rarefaction in two cases. However, further MRI showed extensive changes closely correlated with the clinical signs of cutaneous vasculopathic rashes. The MRI abnormalities were notable, encompassing marrow oedema primarily affecting metaphyses and epiphyses, displaying broad transition zones. Soft tissue swelling and cortical erosions were also observed. These MRI features proved more pathognomonic in the acute clinical context. The study concluded that phalangeal microgeodic syndrome, characterised by digital swelling and erythema, might not be adequately assessed by plain X-rays. The more comprehensive MRI features, including marrow oedema and soft tissue abnormalities, appeared to be more indicative in diagnosing the condition. Considering the rarity of this syndrome and its temporal association with the COVID-19 pandemic, the study hypothesised that COVID-related thrombophilia and immune-mediated vasculopathy might act as crucial triggers for the active bony manifestations seen in this syndrome. KEY POINTS: • PMS is a rare, predominantly paediatric condition, of unknown aetiology which affects the digits. • Laboratory investigations are generally negative; however, in the appropriate clinical context, the X-ray findings of microgeodes and pattern of bone marrow oedema seen on MRI are pathognomonic. • Considering the rarity of PMS and temporal association with the COVID-19 pandemic, COVID vasculopathy may represent a previously unrecognised aetiology for PMS.

Relationships between bone age, physical performance, and motor coordination among adolescent male and female athletes.

Biological maturity significantly impacts youth athletes' physical performance throughout adolescence. However, how this differs between male and female youth athletes remains unclear. Thus, the present study aimed to assess associations between maturity, physical performance and motor coordination in females and males. Sixty-eight youth athletes (mean age 13.9 ± 0.8 years, 26 females) were included in the present study. Participants performed a 40 m sprint, standing long jump (SLJ), push-ups and a 2,000 m run. Motor coordination was evaluated using the short form of the Körperkoordinationstest für Kinder test. Bone age (BA), assessed by x-ray of the left hand and analyzed with an automated software, was used as a biomarker of biological maturity. Results showed that BA was significantly associated with performance for males on 40 m sprint (r = -.556, p < .001), SLJ (r = .500, p < .001) and 2,000 m run (r = -.435, p = .011). No associations were found between BA and physical performance among females, nor between BA and motor coordination for either females or males. In conclusion, maturity is associated with exercises that require maximal speed, explosive leg strength and endurance in males, but not in females, with maturity showing no impact on the motor coordination in either sex.

A Juxta-Articular Myxoma of the Thumb in a young male: A case report

Juxta-articular myxomas are benign tumours that are most commonly associated with larger joints. Cases involving hand have been rarely reported till date. We present a case of a juxta-articular myxoma at the metacarpophalangeal joint of the thumb in a 30-year-old male patient. The preoperative diagnostic work-up included ultrasound and X-ray of left hand. The histopathological examination of the resected tumor confirmed the diagnosis. Follow-up ultrasound six months after surgery revealed no obvious recurrence. At 6 months, the patient had full range of motion without pain.

Prevalence and Variations of Sesamoid Bones in the Hands of Patients Visiting Teaching Hospital of Kaski District: A Retrospective Study

Introduction: Sesamoids are small, well-corticated, ovoid or nodular, may be bipartite ormultipartite bones/ossifications found close to a bone or a joint that are subject to significant morphological variations. Although it is difficult to determine the symptomatic nature of these bones, imaging provides important diagnostic information. The objective of this study is to assess the prevalence and variations of sesamoid bone in hands of patients visiting a teaching hospital of Kaski district.&#x0D; Methods: A hospital based retrospective cross-sectional study was conducted by analyzing X-rays of hand with Anteroposterior (AP) view, a total of 150 both male and female patients between the age group of 18 to 85 wereimaged between August 1, 2022 to December 30, 2022 at Department of Radiology &amp; Imaging(X-Ray Unit). Presence of sesamoid bone of hand was noted on 1st, 2nd, 3rd, 4th and 5th metacarpophalangeal joints (MCPj), and the 1st interphalangeal joint (IPj), separately. The data were analyzed for correlation using Pearson’s correlation test. Ethical approval was taken from the Institutional Review Committee of Gandaki Medical College (Reference No.159/079/080).&#x0D; Results: The prevalence of sesamoid bone at 1st, 2nd, 3rd, 4th and 5th MCPj, and 1st IPj were 100 (100%), 60 (46%), 24(16%), 20(13.3%), 100(66.7%), and 114(76%) respectively. Variation was more prominent among females at 2nd, 3rdand 5th MCPj and 1st IPj, Also, SB variation was more prominent on left hand compared to right hand in 2nd, 4thand 5th MCPj and 1st IPj.&#x0D; Conclusions:No significant correlation between the gender and laterality with presence or absence of SB in the hands were noted.

Determination of Distributional Characteristics and Efficacy of Hand Radiographic Damage in Patients with Rheumatoid Arthritis Using a Novel Damage Assessment Method

Background: The purpose of this study was to identify the distribution characteristics of radiological damage to the hand of rheumatoid arthritis patients and evaluate its effectiveness using a new damage assessment method.Methods: Hand radiographs of a total of 127 rheumatoid arthritis patients were evaluated. We simplified the pre-existing van der Heijde modified total sharp score to assess the extent of bone damage. We selected 36 joints in both hands as regions of interest in our own way, and the erosion and joint space narrowing were scored.Results: When the erosion and joint space narrowing score values of each joint of the hand were added together, the joint space narrowing score was higher than the overall erosion score. We can see that the scaphoid,lunate,radius and ulnar joints have higher erosion scores, and the 4th proximal interphalangeal (PIP), Scaphoid, Lunate, and Radius joints have higher joint space narrowing scores than other joints. These damage assessment results were similar to the results from the previous damage assessment model.Conclusions: The joint space narrowing score is higher than the erosion score, suggesting that joint space narrowing precedes erosion. When checking the hand X-ray of rheumatoid arthritis patients, it is necessary to carefully check the scaphoid,lunate,radius and ulnar and 4th PIP joints, which relatively high radiographic damage scores. Also, the damage assessment model used in this study is relatively simple and does not show difference in analysis results from existing assessment models, so it can be considered for application in follow-up research.

Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis

BackgroundA variety of surgical techniques had been developed over the past few decades for treating thumb carpometacarpal joint (CMCJ) osteoarthritis (OA). However, there are currently no accepted consensus on the ideal treatment for thumb CMCJ OA. Arthrodesis was one of the widely popular treatment methods; however, studies have showed that non-union rates were as high as 50%, with higher complications such as osteoarthritis of neighbouring joints and higher revision surgeries required as compared to other surgical methods. Patients with arthrodesis were also reported to have decreased thumb range of motion and loss of opponens function. Currently, there are numerous intraoperative positioning techniques for arthrodesis which could be confusing for young surgeons. With recent developments of fixation plates and better understanding of the wrist anatomy, this retrospective review aimed to evaluate the efficacy of our intraoperative hand-grip positioning method for arthrodesis of thumb CMCJ OA. What are the postoperative functional outcomes of (1) T-hook plates and (2) our intraoperative hand-grip positioning method for Eaton III thumb CMCJ OA arthrodesis by evaluating pain visual analogue scale (VAS) score, Disabilities of the Arm, Shoulder and Hand questionnaires (DASH), Mayo Wrist scores, capability of thumb opposition (Kapandji score), and comparing pre- and postoperative grip and pinch strength?MethodsTwenty patients with CMCJ OA underwent arthrodesis using our intraoperative hand-grip positioning method and T-hook plates and screws (Acumed, USA). Patients were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Radiologic assessment including fusion evaluation, evaluation of radial and palmar abduction angles was done on hand X-rays.ResultsTwenty patients with a minimum follow-up duration of 12 months were included in this study. 100% fusion rate was achieved with only 1 case of complication involving radial sensory nerve neuropathy which was resolved after removal of implant and neurolysis. Significant improvement in pain and Mayo Wrist scores were noted 3 months postoperatively, whilst DASH score exhibited significant improvements after 6 months of follow-up (p < 0.05). Even though there were no significant differences observed between preoperative and postoperative grip strength, pinch strength and Kapandji scores, positive recovery trends were noted for all parameters with these functions surpassing preoperative levels after 12 months of follow-up. Significant improvements on hand X-rays were also noted for both postoperative radial and palmar abduction angles.ConclusionsThere is currently no consensus on the ideal treatment method for thumb CMCJ OA. In this study, we would like to propose a simple intraoperative hand-grip positioning method with T-hook plates for arthrodesis. As seen from our results, our technique was able to provide satisfactory and replicable postoperative results and thus we would like to propose our hand-grip positioning method with T-hook plates fixation for subsequent treatment of patients with Eaton stage III thumb CMCJ OA.

Skeletal age evaluation using hand X-rays to determine growth problems

A common clinical method for identifying anomalies in bone growth in infants and newborns is skeletal age estimation with X-ray images. Children’s bone abnormalities can result from several conditions including wounds, infections, or tumors. One of the most frequent reasons for bone issues is that most youngsters are affected by the slow displacement of bones caused by pressure applied to the growth plates as youngsters develop. The growth plate can be harmed by a lack of blood supply, separation from other parts of the bone, or slight misalignment. Problems with the growth plate prevent bones from developing, cause joint distortion, and may cause permanent joint injury. A significant discrepancy between the chronological and assessed ages may indicate a growth problem because determining bone age represents the real level of growth. Therefore, skeletal age estimation is performed to look for endocrine disorders, genetic problems, and growth anomalies. To address the bone age assessment challenge, this study uses the Radiological Society of North America’s Pediatric Bone Age Challenge dataset which contains 12,600 radiological images of the left hand of a patient that includes the gender and bone age information. A bone age evaluation system based on the hand skeleton guidelines is proposed in this study for the detection of hand bone maturation. The proposed approach is based on a customized convolutional neural network. For the calculation of the skeletal age, different data augmentation techniques are used; these techniques not only increase the dataset size but also impact the training of the model. The performance of the model is assessed against the Visual Geometry Group (VGG) model. Results demonstrate that the customized convolutional neural network (CNN) model outperforms the VGG model with 97% accuracy.

The importance of skeletal x-ray screening for dysostosis multiplex in the early diagnosis of mucopolysaccharidosis

PurposeOur aim is the early detection of mucopolysaccharidosis (MPS) by examining the radiographs taken for reasons other than a metabolic disease, such as infection, trauma, and short stature. MethodsThe radiographs of children who applied to outpatient and emergency clinics in our hospital between 01/01/2022 and 31/12/2022 were examined by a pediatric radiologist retrospectively without knowledge of patient information. The MPS enzyme panel and urine glycosaminoglycan analysis were performed in patients having dysostosis multiplex on radiographs. In cases with MPS detected by enzyme and urine analysis, the definitive diagnosis was confirmed by genetic analysis. ResultsSkeletal radiographs of 15.104 cases admitted to our hospital were examined (11,270 chest x-ray, 314 lumbosacral spine x-ray, 2970 hand x-ray, 253 pelvis x-ray, 162 skull x-ray, and 135 complete skeletal surveys). In 67 children, dysostosis multiplex was observed in the skeletal X-ray. Among them, seven newly diagnosed MPS cases were detected. Three cases were diagnosed with MPS type 4A, two with MPS type 6, one with MPS type 2 and one with MPS type 3B. Age at diagnosis was 46.2 ± 30.6 months (range; 20–111 months). There was a history of consanguinity in 6 (85.7%) cases. ConclusionRadiographs can provide clues for diagnosing MPS before the clinical findings become prominent in children admitted to the hospital for other complaints. Therefore, X-ray screening can be performed on children in endemic regions of MPS to search for dysostosis multiplex.

Improvement in Growth in Adolescents with Average Height Using A Massage Chair: A Prospective Single Arm Pre-Post and National Standard Data Comparison Study

Background: This study aimed to examine the changes in height, weight, and bone age between pre- and post-intervention when using a BEG-100 massage chair daily.Methods: Thirty-five children aged 11 years who were close to the average height (145-155 cm) were included in the study. There were 34 participants who used the BEG-100 massage chair for 24 weeks. Daily intervention consisted of 20 minutes of lower body massage and 10 minutes of whole-body massage. Height, weight, and adverse events were checked every five visits, while a hand X-ray was used before and after massages. The height percentile and height standard deviation score (SDS) were calculated using the 2017 Korean growth chart. The bone age and predicted adult height using radiographs were computed using the Tanner-Whitehouse method. The paired t-test or Wilcoxon signed-rank test was used according to normality of data to determine statistical significance.Results: A total of 31 children were included in the final analysis. The height percentile and height SDS significantly increased after BEG-100 massage chair use (2.39; &lt;i&gt;p&lt;/i&gt; = 0.032, and 0.07; &lt;i&gt;p&lt;/i&gt; = 0.036, respectively). However, these changes were not significant in children whose baseline height was shorter than the average. There were no significant differences in bone age, height for bone age, predicted adult height, or sitting height/height ratio. None of the participants complained of adverse events.Conclusion: The height percentile and SDS of teenagers increased after use of massage chair therefore, it is necessary to perform larger randomized controlled clinical studies. Trial registration: KCT0004673.