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PURPOSE: This study proposes a system that can simulate head radiography by combining a technique for estimating human posture from moving images (hereafter referred to as "pose estimation technique") and use of two cameras capable of acquiring RGB images to determine body position during positioning. METHODS: The angles of the median sagittal plane (MS), axial plane (AX), and orbitomeatal baseline (OM) were obtained using the pose estimation technique from frontal and lateral images captured after positioning. The resulting radiographs were displayed according to the results. RESULTS: The head tilt during positioning could be determined based on the coordinate data of feature points acquired using the pose estimation technique. In an imaging experiment using a simulated human patient, errors increased as head tilt increased; however, the mean error values in each axis were 0.9° for MS, 0.8° for AX, and 1.5°for OM, when the patient was correctly positioned. CONCLUSION: The pose estimation technique can assist in evaluating positioning accuracy in radiography and is expected to be used as a potential simulator system.
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Cabeza , Postura , Humanos , Cabeza/diagnóstico por imagen , Radiografía/instrumentación , Radiografía/métodos , Posicionamiento del PacienteRESUMEN
During the radiographic examination of the chest and bones in hospitals, communicating and maintaining posture is difficult for some patients, and movement before or during X-ray irradiation may necessitate re-exposure owing to body wobbling movements or breathing movements. To prevent the need for re-exposure during radiography and to determine the exposure timing, a body movement detection system that considers breathing movements was developed in this study. The posture of a patient was monitored using an RGB camera. The acquired video data was analyzed to detect body movement using either an inter-frame difference method or an optical flow estimation method. The performance of the system was evaluated by detecting the body and breathing movements during positioning. Consequently, the inter-frame difference method detected 179.8-1222.2 pixels during body movements, and the optical flow estimation method confirmed that the feature points moved by 5.5-26.6 mm (4.2-20.3 pixels). When detecting breathing movements, 82-585 pixels were detected by the inter-frame difference method, and the optical flow estimation method showed that the feature points moved by 5.2 mm (2-4 pixels). Therefore, the proposed method can detect body movements during radiography to prevent re-exposure due to body wobble and breathing movements. For healthcare providers, it will lead to reduce not only concerns about patient exposure but also unnecessary radiographic workload.
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Movimiento , Humanos , Radiografía/instrumentación , Radiografía/métodos , Respiración , Postura , Exposición a la Radiación/prevención & control , Exposición a la Radiación/análisisRESUMEN
Introduction: to address the challenge of inadequate and non-equitable distribution of diagnostic imaging equipment, countries are encouraged to evaluate the distribution of installed systems and undertake adequate monitoring to ensure equitability. Ghana´s medical imaging resources have been analyzed in this study and evaluated against the status in other countries. Methods: data on registered medical imaging equipment were retrieved from the database of the Nuclear Regulatory Authority and analyzed. The equipment/population ratio was mapped out graphically for the 16 regions of Ghana. Comparison of the equipment/population ratio was made with the situation in other countries. Results: six hundred and seventy-four diagnostic imaging equipment units from 266 medical imaging facilities (2.5 units/facility), comprising computed tomography (CT), general X-ray, dental X-ray, single-photon emission computed tomography (SPECT) gamma camera, fluoroscopy, mammography and magnetic resonance imaging (MRI) were surveyed nationally. None of the imaging systems measured above the Organization for Economic Co-operation and Development (OECD) average imaging units per million populations (u/mp). The overall equipment/population ratio estimated nationally was 21.4 u/mp. Majority of the imaging systems were general X-ray, installed in the Greater Accra and Ashanti regions. The regional estimates of equipment/population ratios were Greater Accra (49.6 u/mp), Ashanti (22.4 u/mp), Western (21.4 u/mp), Eastern (20.6 u/mp), Bono East (20.0 u/mp), Bono (19.2 u/mp), Volta (17.9 u/mp), Upper West (16.7 u/mp), Oti (12.5 u/mp), Central (11.9 u/mp), Northern (8.9 u/mp), Ahafo (8.9 u/mp), Upper East (6.9 u/mp), Western North (6.7 u/mp), Savannah (5.5 u/mp) and North-East (1.7 u/mp). Conclusion: medical imaging equipment shortfall exist across all imaging modalities in Ghana. A wide inter-regional disparity in the distribution of medical imaging equipment exists contrary to WHO´s recommendation for equitable distribution. A concerted national plan will be needed to address the disparity.
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Equipo para Diagnóstico , Diagnóstico por Imagen , Equidad en Salud , Instituciones de Salud , Disparidades en Atención de Salud , Equipo para Diagnóstico/normas , Equipo para Diagnóstico/estadística & datos numéricos , Equipo para Diagnóstico/provisión & distribución , Diagnóstico por Imagen/instrumentación , Diagnóstico por Imagen/estadística & datos numéricos , Fluoroscopía/instrumentación , Ghana/epidemiología , Equidad en Salud/estadística & datos numéricos , Instituciones de Salud/estadística & datos numéricos , Instituciones de Salud/provisión & distribución , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Mamografía/instrumentación , Radiografía/instrumentaciónRESUMEN
Introducción: la artroplastia reversa de hombro (RSA, por su nombre en inglés) con un centro de rotación lateralizado ha demostrado reducir las tasas de notching, restaurar el contorno del hombro y mejorar la rotación externa. La lateralización puede lograrse desde el componente glenoideo o desde el vástago humeral. Boutsadis et al. describieron dos mediciones angulares en radiografías postoperatorias para determinar objetivamente la lateralización y la distalización en la RSA: el ángulo de lateralización del hombro (LSA, por su nombre en inglés) y el ángulo de distalización del hombro (DSA, por su nombre en inglés). Estas mediciones son reproducibles y se correlacionan con los resultados funcionales y la amplitud de movimiento. La prótesis DJO (DJO Surgical, Austin, TX, EE. UU.) presenta una glenosfera con centro de rotación lateralizado, con un ángulo cuello-eje de 135°. Este implante ha dado resultados clínicos satisfactorios en los estudios de seguimiento a medio y largo plazo. Hasta la fecha, no se ha descripto la medición objetiva de los índices de lateralización y su asociación con la amplitud de movimiento postoperatorio mediante LSA y DSA en este tipo de implante. Materiales y métodos: se realizó una revisión retrospectiva de las artroplastias inversas de hombro efectuadas en una única institución por un único cirujano de hombro formado en la especialidad (autor principal) entre enero de 2014 y abril de 2021. Se incluyeron los pacientes que se sometieron a una RSA por artropatía del manguito rotador o por osteoartritis glenohumeral primaria con un implante lateralizado en el lado de la glenoides y un ángulo cuello-eje de 135°. En todos los pacientes se obtuvo una radiografía postoperatoria para evaluar las medidas radiográficas de la LSA y la DSA. Las radiografías fueron revisadas de manera independiente por tres autores y se evaluó la concordancia entre los examinadores. Resultados: un total de treinta y nueve pacientes cumplieron los criterios de inclusión. Su edad media fue de 77.5 años, y la distribución por sexos fue de un 74.3% de mujeres. La mediana final de rotación externa activa fue de 26° y la mediana final de flexión activa hacia adelante fue de 125°. El análisis radiográfico realizado por los tres revisores dio como resultado un ángulo de lateralización con un punto de corte de 93° (73° 118°) y un ángulo de distalización con un punto de corte de 40° (15° 65°). El coeficiente de correlación entre los tres evaluadores para el ángulo de lateralización fue de 0.59 y para el ángulo de distalización fue de 0.79.Discusión: el principal hallazgo de esta investigación es que un implante RSA con lateralización glenoidea proporciona una lateralización objetiva con LSA de 93° y una distalización con DSA de 40°. Estos resultados cumplen el rango ideal para la restauración óptima del movimiento. Las mediciones radiográficas postoperatorias de la lateralización y la distalización para este tipo de implante son reproducibles entre diferentes observadores. Nivel de Evidencia: IV
Introduction: reverse shoulder arthroplasty (RSA) with a lateralized center of rotation has proven to reduce notching rates, restore shoulder contour and improve external rotation. Lateralization can be achieved from the glenoid component or from the humeral stem. Boutsadis et al. described two angular measurements on postoperative radiographs to objectively determine lateralization and distalization in RSA: the lateralization shoulder angle (LSA) and the distalization shoulder angle (DSA). These measurements are reproducible, and they correlate with functional outcomes and range of motion. The DJO prosthesis (DJO Surgical, Austin, TX, USA) features a lateralized center of rotation glenosphere, with a neck-shaft angle of 135°. This implant has yielded satisfactory clinical outcomes in the medium, and long term follow-up studies. To date, objective measurement of lateralization rates and their association postoperative range of motion using LSA and DSA has not been described in this type of implant.Materials and methods: a retrospective review was performed of reverse shoulder arthroplasties performed in a single institution by a single fellowship trained shoulder surgeon (senior author) between January 2014 and April 2021. Patients were included if they underwent a RSA for rotator cuff arthropathy or primary glenohumeral osteoarthritis with a glenoid-side lateralized implant and a 135° neck-shaft angle. In all patients, a postoperative X-ray was obtained in order to evaluate the radiographic measurements of LSA and DSA. Radiographs were independently reviewed by three authors and the agreement between the examiners was assessed.Results: a total of thirty-nine patients met the inclusion criteria. Their average age was 77.5 years, the sex distribution was 74.3% female patients. Final median active external rotation was 26° and final median active forward flexion was 125°. The radiographic analysis performed by the three reviewers resulted in a lateralization angle with a cut-off point of 93° (73° 118°) and a distalization angle with a cut-off point of 40° (15° 65°). The correlation coefficient between the three evaluators for the lateralization angle was 0.59and for the distalization angle was 0.79.Discussion: the main finding of this research is that an RSA implant with glenoid-side lateralization provides an objective lateralization with LSA of 93° and a distalization with DSA of 40°. These results met the ideal range for optimal restoration of motion. Postoperative radiographic lateralization and distalization measurements for this type of implant are reproducible between different observers. Level of Evidence: IV
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Articulación del Hombro/cirugía , Rango del Movimiento Articular , Artroplastía de Reemplazo de Hombro/estadística & datos numéricos , Radiografía/instrumentación , Estudios Retrospectivos , Artropatía por Desgarro del Manguito de los Rotadores/cirugía , Prótesis de HombroAsunto(s)
Pediatría , Radiografía , Radiología , Adolescente , Niño , Preescolar , Humanos , Lactante , Pediatría/métodos , Dosis de Radiación , Exposición a la Radiación/prevención & control , Interpretación de Imagen Radiográfica Asistida por Computador , Radiografía/instrumentación , Radiografía/métodos , Radiología/instrumentación , Radiología/métodos , Rayos XRESUMEN
PURPOSE: The purpose of this study was to review our institutional experience with the EOS machine in order to identify the incidence and clinical significance of incidental extraspinal findings (IESF) in an adult spinal deformity population. METHODS: Our institutional database was queried for all full-length standing radiographs generated by the EOS machine. Dictations were reviewed and the number of incidental extraspinal findings were classified using a previously described system. All findings related to the spine were excluded. A subset of electronic medical records were reviewed to determine further workup for individual findings of suspected clinical significance. RESULTS: Original database query based on radiology reports returned a total of 1857 EOS studies. Duplicate studies, studies without the entire body, and patients with more than 1 study during the search period were excluded. 503 patient studies (55.5% female, mean age 59-years-old, range 18 to 91-years-old) met inclusion criteria. The overall rate of incidental extraspinal findings in our study was 60.4% (304 findings in 503 patients). Most findings were classified as Minor. The rate of Major and Moderate findings was 4.8%. The final rate of clinically significant incidental extraspinal findings was 0.8% and included 3 presumed metastatic lesions in long bones and 1 pulmonary nodule. CONCLUSION: To our knowledge this is the first study that reports the rate of incidental extraspinal findings on full body EOS studies. We report a low rate (0.8%) of clinically significant incidental extraspinal findings which is lower than that of CT or MRI. Further research is warranted in comparing EOS and standard radiography.
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Huesos/diagnóstico por imagen , Hallazgos Incidentales , Radiografía/métodos , Posición de Pie , Imagen de Cuerpo Entero/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/diagnóstico por imagen , Femenino , Pinzamiento Femoroacetabular/diagnóstico por imagen , Humanos , Artropatías/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Exposición a la Radiación , Radiografía/instrumentación , Columna Vertebral/anomalías , Columna Vertebral/diagnóstico por imagen , Imagen de Cuerpo Entero/instrumentación , Adulto JovenRESUMEN
An 81-year-old woman who underwent percutaneous endoscopic gastrostomy (PEG) a year before, after cerebral infarction was receiving home medical care. The first accidental PEG tube removal occurred after clinic hours, and the home-care doctor visited her home to quickly reinsert the tube. After the narrowed fistula was dilated, the tube was reinserted with a guide wire. An X-ray taken with a CALNEO Xair, which is an easily portable X-ray system launched in 2018, confirmed that the tip of the PEG tube was successfully placed in the stomach. A similar accidental removal occurred 2 months later, and we managed it in the same way. Both events were resolved with a single radiograph without significant difficulty. With in-home medical care, PEG tube replacement can be performed easily and safely with a handy portable X-ray system.
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Remoción de Dispositivos , Nutrición Enteral/métodos , Gastrostomía/instrumentación , Servicios de Atención de Salud a Domicilio , Radiografía/instrumentación , Anciano de 80 o más Años , Femenino , Humanos , Estómago/diagnóstico por imagenRESUMEN
INTRODUCTION: Displaced unstable pelvic injuries are life threatening and require rapid reduction and stabilisation, typically achieved with an external fixator. Recently, the benefits of supra-acetabular pins have been proven; however, these are usually inserted under fluoroscopic guidance. In austere environments and in extremis, this facility is limited and fixation using anatomical landmarks is required. Thus, the aim of this study is to determine the relative position of the supra-acetabular bone to the crestal plane and examine its consistency in military-aged European personnel. METHODS: A radiological review of 50 randomised pelvic CT scans in European patients aged 18-30 years from a Level 1 trauma centre was performed. The CT scans were analysed using 3D rendering software. The relative position of the supra-acetabular bone to the crestal plane was determined. RESULTS: The supra-acetabular bone relative to the crestal plane was approximately 28° caudal and 24° medial to the crestal plane. The mean minimum distance from the pin's entry point to the sciatic notch was approximately 73 mm. There were no differences noted between genders or hemipelvic side. CONCLUSIONS: The supra-acetabular bone maintains a consistent relative position to the crestal plane. Thus, with the surgeon's thumb on the anterior superior iliac spine (ASIS) and index finger on the iliac tubercle, defining the crestal plane, a supra-acetabular pin can be inserted into the anterior inferior iliac spine, which lies 3 cm inferior and 2 cm medial to the ASIS, and advanced along the supra-acetabular bone by angling the pin 30° caudal and 25° medial to the crestal plane.
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Acetábulo/diagnóstico por imagen , Luxación de la Cadera/diagnóstico por imagen , Radiografía/métodos , Acetábulo/lesiones , Adulto , Análisis de Varianza , Femenino , Luxación de la Cadera/fisiopatología , Humanos , Masculino , Radiografía/instrumentación , Radiografía/estadística & datos numéricos , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricosRESUMEN
INTRODUCTION: Imaging is essential for the initial diagnosis and monitoring of the novel coronavirus, which emerged in Wuhan, China. This study aims to assess the insight of radiographers on how the COVID-19 pandemic has affected their work routine and if protective measures are applied. METHOD: A prospective observational study was conducted among radiographers registered in the Cyprus Society of Registered Radiologic Technologists & Radiation Therapy Technologists. A questionnaire composed of 28 multiple choice questions was utilised, and the data analysis was performed using SPSS software with the statistical significance assumed as p-value < 0.05. RESULTS: Out of 350 registered radiographers, 101 responses were received. The results showed that there are statistically significant differences regarding the working hours, the feeling of stress, the work effectiveness, the average examination time, the presence of a protocol used among the different workplaces of the participants; a private radiology centre, a private hospital or a public hospital, with a p-value 0.0022, 0.015, 0.027, 0.001, 0.0001 respectively. Also, statistically significant differences were observed in the decontamination methods used for equipment (p-value 0.007), for air (p-value 0.04) and when decontamination takes place (p-value 0.00032) among the different workplaces of the participants. Nonetheless, the majority of radiographers believe that their workplace is sufficiently provided with PPE, cleaning supplies, equipment, and with cleaning personnel and are optimistic regarding the adequacy of these provisions in the next three months. CONCLUSION: This study showed that in the Republic of Cyprus, there are protocols regarding protective measures against COVID-19, and the radiographers are adequately trained on how to face an infectious disease outbreak. However, work is needed in order to develop protocols that reassure the safety of patients and medical personnel while managing the excess workload effectively. IMPLICATIONS FOR PRACTICE: This study indicates the importance of applying protective measures and protocols in the radiology departments in order to minimise the spread of the virus.
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COVID-19/epidemiología , Protocolos Clínicos , Control de Infecciones/métodos , Pandemias , Radiografía/psicología , Radiografía/normas , Adulto , Actitud del Personal de Salud , COVID-19/diagnóstico , COVID-19/diagnóstico por imagen , COVID-19/transmisión , Prueba Serológica para COVID-19 , Chipre/epidemiología , Descontaminación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estrés Laboral , Equipo de Protección Personal , Práctica Privada , Estudios Prospectivos , Radiografía/instrumentación , Servicio de Radiología en Hospital , SARS-CoV-2 , Encuestas y Cuestionarios , Carga de Trabajo , Adulto JovenRESUMEN
Skull fractures are common in children both due to abuse and accidental incidences. The accurate detection of these fractures may therefore be critical. The aim of this study was to investigate the reliability of CT, X-ray, and Lodox® scans, the latter which has not previously been evaluated and is commonly employed in South Africa, in detecting the number, location and type of pediatric skull fractures. Blunt force trauma was inflicted with a mallet on ten piglet skulls, which were CT, X-ray, and Lodox® scanned and then macerated. The number, location, and type of skull fractures visible using each imaging modality, and on the cleaned skulls, were recorded. Sensitivities and specificities of each method were calculated. For fracture number and location, CTs had a sensitivity of 47.3%, X-rays 22.4% and Lodox® 23.3%. For fracture type, sensitivities were 46.1%, 16.6%, and 17.8% for CT, X-ray, and Lodox® , respectively. Specificities were high (92.5%-100%) which reduces the risk of incorrectly diagnosing fractures. However, low sensitivities increase the risk of failing to identify fractures and possible victims of abuse. Osteological analysis should preferably be the method of choice when evaluating pediatric skull trauma, and CTs should be used when osteological analysis is not feasible. If CT scanners are not available, X-rays and Lodox® may have to be used. In these cases, additional radiographic views of the skull are imperative and may increase the sensitivity of these methods, although they are not recommended to detect exact pediatric skull fracture number, location, and type.
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Fracturas Craneales/diagnóstico por imagen , Animales , Medicina Legal , Modelos Animales , Radiografía/instrumentación , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Porcinos , Tomografía Computarizada por Rayos XRESUMEN
Radiographic imaging with x-rays and protons is an omnipresent tool in basic research and applications in industry, material science and medical diagnostics. The information contained in both modalities can often be valuable in principle, but difficult to access simultaneously. Laser-driven solid-density plasma-sources deliver both kinds of radiation, but mostly single modalities have been explored for applications. Their potential for bi-modal radiographic imaging has never been fully realized, due to problems in generating appropriate sources and separating image modalities. Here, we report on the generation of proton and x-ray micro-sources in laser-plasma interactions of the focused Texas Petawatt laser with solid-density, micrometer-sized tungsten needles. We apply them for bi-modal radiographic imaging of biological and technological objects in a single laser shot. Thereby, advantages of laser-driven sources could be enriched beyond their small footprint by embracing their additional unique properties, including the spectral bandwidth, small source size and multi-mode emission.
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Gryllidae/ultraestructura , Imagen Multimodal/métodos , Radiografía/métodos , Animales , Rayos Láser , Imagen Multimodal/instrumentación , Protones , Radiografía/instrumentación , Rayos XRESUMEN
Importance: Chest radiography is the most common diagnostic imaging examination performed in emergency departments (EDs). Augmenting clinicians with automated preliminary read assistants could help expedite their workflows, improve accuracy, and reduce the cost of care. Objective: To assess the performance of artificial intelligence (AI) algorithms in realistic radiology workflows by performing an objective comparative evaluation of the preliminary reads of anteroposterior (AP) frontal chest radiographs performed by an AI algorithm and radiology residents. Design, Setting, and Participants: This diagnostic study included a set of 72 findings assembled by clinical experts to constitute a full-fledged preliminary read of AP frontal chest radiographs. A novel deep learning architecture was designed for an AI algorithm to estimate the findings per image. The AI algorithm was trained using a multihospital training data set of 342â¯126 frontal chest radiographs captured in ED and urgent care settings. The training data were labeled from their associated reports. Image-based F1 score was chosen to optimize the operating point on the receiver operating characteristics (ROC) curve so as to minimize the number of missed findings and overcalls per image read. The performance of the model was compared with that of 5 radiology residents recruited from multiple institutions in the US in an objective study in which a separate data set of 1998 AP frontal chest radiographs was drawn from a hospital source representative of realistic preliminary reads in inpatient and ED settings. A triple consensus with adjudication process was used to derive the ground truth labels for the study data set. The performance of AI algorithm and radiology residents was assessed by comparing their reads with ground truth findings. All studies were conducted through a web-based clinical study application system. The triple consensus data set was collected between February and October 2018. The comparison study was preformed between January and October 2019. Data were analyzed from October to February 2020. After the first round of reviews, further analysis of the data was performed from March to July 2020. Main Outcomes and Measures: The learning performance of the AI algorithm was judged using the conventional ROC curve and the area under the curve (AUC) during training and field testing on the study data set. For the AI algorithm and radiology residents, the individual finding label performance was measured using the conventional measures of label-based sensitivity, specificity, and positive predictive value (PPV). In addition, the agreement with the ground truth on the assignment of findings to images was measured using the pooled κ statistic. The preliminary read performance was recorded for AI algorithm and radiology residents using new measures of mean image-based sensitivity, specificity, and PPV designed for recording the fraction of misses and overcalls on a per image basis. The 1-sided analysis of variance test was used to compare the means of each group (AI algorithm vs radiology residents) using the F distribution, and the null hypothesis was that the groups would have similar means. Results: The trained AI algorithm achieved a mean AUC across labels of 0.807 (weighted mean AUC, 0.841) after training. On the study data set, which had a different prevalence distribution, the mean AUC achieved was 0.772 (weighted mean AUC, 0.865). The interrater agreement with ground truth finding labels for AI algorithm predictions had pooled κ value of 0.544, and the pooled κ for radiology residents was 0.585. For the preliminary read performance, the analysis of variance test was used to compare the distributions of AI algorithm and radiology residents' mean image-based sensitivity, PPV, and specificity. The mean image-based sensitivity for AI algorithm was 0.716 (95% CI, 0.704-0.729) and for radiology residents was 0.720 (95% CI, 0.709-0.732) (P = .66), while the PPV was 0.730 (95% CI, 0.718-0.742) for the AI algorithm and 0.682 (95% CI, 0.670-0.694) for the radiology residents (P < .001), and specificity was 0.980 (95% CI, 0.980-0.981) for the AI algorithm and 0.973 (95% CI, 0.971-0.974) for the radiology residents (P < .001). Conclusions and Relevance: These findings suggest that it is possible to build AI algorithms that reach and exceed the mean level of performance of third-year radiology residents for full-fledged preliminary read of AP frontal chest radiographs. This diagnostic study also found that while the more complex findings would still benefit from expert overreads, the performance of AI algorithms was associated with the amount of data available for training rather than the level of difficulty of interpretation of the finding. Integrating such AI systems in radiology workflows for preliminary interpretations has the potential to expedite existing radiology workflows and address resource scarcity while improving overall accuracy and reducing the cost of care.
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Inteligencia Artificial/normas , Internado y Residencia/normas , Interpretación de Imagen Radiográfica Asistida por Computador/normas , Tórax/diagnóstico por imagen , Algoritmos , Área Bajo la Curva , Inteligencia Artificial/estadística & datos numéricos , Humanos , Internado y Residencia/métodos , Internado y Residencia/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Curva ROC , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/estadística & datos numéricos , Radiografía/instrumentación , Radiografía/métodosRESUMEN
Nurses have a vital role in providing nursing care to patients requiring mobile radiography. Mobile radiography is requested when a patient's condition makes it impossible for them to be transported to the radiology department. All health professionals involved in mobile radiography, such as nurses, medical doctors and radiographers should be knowledgeable in this area. This is even more important in current practice, where nurse consultants and nurse advanced practitioners are assessing and referring patients for limited radiological examinations. However, there is little literature to equip nurses with knowledge about mobile radiography. The aim of this article is to raise awareness of this subject at a time when the number of patients requiring mobile radiography has increased globally, due to the outbreak of coronavirus. Critically ill patients with COVID-19 require portable chest X-rays to diagnose complications of the disease, such as pneumonia.
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Radiografía/instrumentación , Radiografía/enfermería , COVID-19 , Competencia Clínica , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Diseño de Equipo , Humanos , Pandemias , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/epidemiologíaRESUMEN
BACKGROUND: Modern healthcare devices can be connected to computer networks and many western healthcare institutions run those devices in networks. At the same time, cyber attacks are on the rise and there is evidence that cybercriminals do not spare critical infrastructure such as major hospitals, even if they endanger patients. Intuitively, the more and closer connected healthcare devices are to public networks, the higher the risk of getting attacked. METHODS: To asses the current connectivity status of healthcare devices, we surveyed the field of German hospitals and especially University Medical Center UMCs. RESULTS: The results show a strong correlation between the networking degree and the number of medical devices. The average number of medical devices is 25.150, with a median of networked medical devices of 3.600. Actual key users of networked medical devices are the departments Radiology, Intensive Care, Radio-Oncology RO, Nuclear Medicine NUC, and Anaesthesiology in the group of UMCs. In the next five years, the usage of networked medical devices will increase significantly in the departments of Surgery, Intensive Care, and Radiology. We detected a strong correlation between the degree of connectivity and the likelihood of being attacked.The survey answers regarding the cyber security status reveal a lack of security basics in some of the inquired hospitals. We did discover successful attacks in hospitals with separated or subsidiary departments. A fusion of competencies on an organizational level facilitates the right behavior here. Most hospitals rated themselves predominantly positively in the self-assessment but also stated the usefulness of IT security insurance. CONCLUSIONS: Concluding our results, hospitals are already facing the consequences of omitted measures within their growing pool of medical devices. Continuously relying on historically grown structures without adaption and trusting manufactures to solve vectors is a critical behavior that could seriously endanger patients.
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Redes de Comunicación de Computadores/organización & administración , Seguridad Computacional , Radiografía/instrumentación , Radiología/instrumentación , Equipos y Suministros , Alemania , Instituciones de Salud , Hospitales , Humanos , Medición de Riesgo , Medidas de SeguridadRESUMEN
This study was aimed at investigating and comparing exposure dose of workers and the surrounding workers. In addition, worker's exposure was also measure about lens and finger. Four intraoral portable X-ray units were evaluated. The stray radiations were measured using Pitman 37D and ionization chamber (Pitman). MyDosemini (ALOKA) was used for measurement of the finger exposure dose. Without the shield became high in anterior 0.5 m. Comparing the air dose for the four models used in this study showed a high tendency for the two NOMAD models. And using the shields, the images could be taken 4.6 times of the baseline at a maximum and 3.6 times on average. The finger radiation exposure dose was low with both of the NOMAD models, with no significant difference found. By setting the baseline value without a shield, finger radiation exposure when using a shield was lower than the detection limit for the D3000, and was reduced by approximately 94-96% for other three models. All models can photograph around 100 bodies, so it is considered that it is not necessary to switch out the operator considering the operation limit. But even if it does not reach the operation limit, the stochastic effects of radiation exposure can be increased as well as the deterministic effects of the operation limit. The operator and the surrounding workers seek to protect themselves. It is important to perform exposure management that takes into account the stochastic effects to the operator and the surrounding workers.
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Exposición Profesional/efectos adversos , Exposición Profesional/análisis , Dosis de Radiación , Radiografía/efectos adversos , Radiografía/instrumentación , Dedos , Humanos , Cristalino , Exposición Profesional/prevención & control , Fantasmas de Imagen , Equipos de Seguridad , Radiografía DentalRESUMEN
BACKGROUND: For several years mobile X-ray equipment has been routinely used for imaging in patients too unwell within the hospital, when transportation to the radiology department was inadvisable. Now, mobile X-ray examinations are also used outside the hospital. The literature describes that fragile patients may benefit from mobile X-ray, but we need to provide insights into the breadth, depth and gaps in a body of literature. METHODS: The scoping review was performed by searching PubMed, Cinahl, Embase, EconLit and Health Technology Assessment. English-, Danish-, Norwegian-, German-, Italian-, French- and Swedish-language studies, published 1.1.2009-1.5.2020 about mobile X-ray outside the hospital were included. Participants were patients examined using mobile X-ray as the intervention. PRISMA was used when eligible to build up the review. To extract data from the selected articles, we used a structured summary table. RESULTS: We included 12 studies in this scoping review. The results were divided into four topics:1. Target population 2. Population health 3. Experience of care and 4. Cost effectiveness. The main findings are that target population could be larger for instance including hospice patients for palliative care, group dwelling for people with intellectual disabilities, or psychiatric patients, population health may be improved, image quality seems to be good and mobile X-ray may be cost effective. Limitations of language, databases and grey literature may have resulted in studies being missed. CONCLUSIONS: Mobile X-ray may be used outside hospital. There seems to be potential benefits to both patients and health care staff. Based on the published studies it is not possible to draw a final conclusion if mobile X-ray examination is a relevant diagnostic offer and for whom. Further studies are needed to assess the feasibility of use in fragile patients, also regarding staff, relatives and societal consequences and therefore the topic mobile X-ray needs more research.
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Radiografía/instrumentación , Telemedicina , Análisis Costo-Beneficio , Humanos , Radiografía/economía , Evaluación de la Tecnología BiomédicaRESUMEN
Portable intraoral X-ray units are frequently used for home-visit dental treatment and personal dental identification. Therefore, the reduction of operator exposure is crucial. Rectangular collimation is effective at reducing patient exposure and operator exposure; however, its effects are not known. We investigated the reduction of operator exposure through rectangular collimation by measuring the backscattered dose in relation to the operator exposure dose. Using a portable intraoral X-ray unit, a head phantom for CT dose measurement as the object, a dosimeter, and stainless-steel rectangular collimator, a 1-cm ambient dose equivalent was measured in intervals of 15° in horizontal and vertical planes with the radii of 50 and 100 cm. The backscattered dose decreased to approximately one-third when a rectangular collimator was attached to the cone tip. This may have been due to the reduction of the volume of scattered X-rays generated in the phantom by rectangular collimation. We clarified that rectangular collimation is effective at reducing the operator exposure and is useful for protecting the operators of portable intraoral X-ray units during home-visit dental treatment and personal dental identification.
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Boca/diagnóstico por imagen , Exposición Profesional/prevención & control , Protección Radiológica/instrumentación , Radiografía/efectos adversos , Radiografía/instrumentación , Exposición Profesional/análisisRESUMEN
PURPOSE: C-arms are portable X-ray devices used to generate radiographic images in orthopedic surgical procedures. Evidence suggests that scouting images, which are used to aid in C-arm positioning, result in increased operation time and excess radiation exposure. C-arms are also primarily used qualitatively to view images, with limited quantitative functionality. Various techniques have been proposed to improve positioning, reduce radiation exposure, and provide quantitative measuring tools, all of which require accurate C-arm position tracking. While external stereo camera systems can be used for this purpose, they are typically considered too obtrusive. This paper therefore presents the development and verification of a low-profile, real-time C-arm base-tracking system using computer vision techniques. METHODS: The proposed tracking system, called OPTIX (On-board Position Tracking for Intraoperative X-rays), uses a single downward-facing camera mounted to the base of a C-arm. Relative motion tracking and absolute position recovery algorithms were implemented to track motion using the visual texture in operating room floors. The accuracy of the system was evaluated in a simulated operating room mounted on a real C-arm. RESULTS: The relative tracking algorithm measured relative translation position changes with errors of less than 0.75% of the total distance travelled, and orientation with errors below 5% of the cumulative rotation. With an error-correction step incorporated, OPTIX achieved C-arm repositioning with translation errors of less than [Formula: see text] mm and rotation errors of less than [Formula: see text]. A display based on the OPTIX measurements enabled consistent C-arm repositioning within 5 mm of a previously stored reference position. CONCLUSION: The system achieved clinically relevant accuracies and could result in a reduced need for scout images when re-acquiring a previous position. We believe that, if implemented in an operating room, OPTIX has the potential to reduce both operating time and harmful radiation exposure to patients and surgical staff.
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Imagenología Tridimensional/instrumentación , Procedimientos Ortopédicos/instrumentación , Radiografía/instrumentación , Algoritmos , Humanos , Imagenología Tridimensional/métodos , Monitoreo Intraoperatorio/instrumentación , RotaciónRESUMEN
In proton-based radiotherapy, proton radiography could allow for direct measurement of the water-equivalent path length (WEPL) in tissue, which can then be used to determine relative stopping power (RSP). Additionally, proton radiographs allow for imaging in the beam's-eye-view. In this work, a proton radiography technique using a flat-panel imager and a pencil-beam scanning (PBS) system is demonstrated in phantom. Proton PBS plans were delivered on a Varian ProBeam system to a flat-panel imager. Each proton plan consisted of energy layers separated by 4.8 MeV, and a field size of 25 cm × 25 cm. All measured data is binned into a layer-by-layer delivery in post processing. To build a calibration curve correlating detector response to WEPL, the plans were delivered to slabs of solid water of increasing thickness. Pixel-by-pixel detector response in the time/energy domain is then fit as a function of WEPL. Tissue equivalent phantoms are imaged for evaluation of WEPL accuracy. A spatial resolution phantom and a head phantom are also imaged. For all experiments, the detector was run with an effective pixel size of 0.4 mm × 0.4 mm. The proposed method reconstructed RSP with mean errors of 2.65%, -0.14%, and 0.61% for lung, soft tissue, and bone, respectively. In a 40 mm thick spatial resolution phantom, a 2 mm deep pinhole with 1 mm diameter can be seen. The accuracy and spatial resolution of the method show that it could be implemented for patient position verification. Further development could lead to patient-specific verification of RSP to be used for treatment guidance.
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Terapia de Protones , Protones , Radiografía/instrumentación , Calibración , Cabeza , Humanos , Fantasmas de Imagen , AguaRESUMEN
In particle therapy, the x-ray based treatment planning converting photon attenuation values to relative stopping power ratio (RSP) introduces clinically relevant range uncertainties. Recently, novel imaging technologies using transmission ion beams have been investigated to directly assess the water equivalent thickness (WET) of tissue, showing improved accuracy in RSP reconstruction, while potentially reducing the imaging dose. Due to their greater availability, protons have been mostly used for ion imaging. To this end, in this work, the influence of three ion species (protons, helium and carbon ions) on the image quality of radiographic WET retrieval has been explored with a dedicated experimental setup and compared to Monte Carlo (MC) simulations. Three phantom setups with different tissue interfaces and features have been irradiated with clinically validated proton, helium and carbon ion pencil beams under comparable imaging dose and beam settings at the Heidelberg Ion-Beam Therapy Center. Ion radiographies (iRADs) were acquired with an integration mode detector, that functions as a range telescope with 61 parallel plate ionization chambers. For comparison, experiments were reproduced in-silico with FLUKA MC simulations. Carbon ions provide iRADs with highest image quality in terms of normalized root mean square error, followed by helium ions and protons. All ions show similar capabilities of resolving WET for the considered phantoms, as shown by the similar average relative error < 3%. Besides for the slab phantom, MC simulations yielded better results than the experiment, indicating potential improvement of the experimental setup. Our results showed that the ability to resolve the WET is similar for all particles, intrinsically limited by the granularity of the detector system. While carbon ions are best suited for acquiring iRADs with the investigated integration mode detector, helium ions are put forward as a less technical challenging alternative.