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1.
Saudi Med J ; 45(5): 531-536, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38734438

RESUMO

OBJECTIVES: To evaluate the role of artificial intelligence (Google Bard) in figures, scans, and image identifications and interpretations in medical education and healthcare sciences through an Objective Structured Practical Examination (OSPE) type of performance. METHODS: The OSPE type of question bank was created with a pool of medical sciences figures, scans, and images. For assessment, 60 figures, scans and images were selected and entered into the given area of the Google Bard to evaluate the knowledge level. RESULTS: The marks obtained by Google Bard in brain structures, morphological and radiological images 7/10 (70%); bone structures, radiological images 9/10 (90%); liver structure and morphological, pathological images 4/10 (40%); kidneys structure and morphological images 2/7 (28.57%); neuro-radiological images 4/7 (57.14%); and endocrine glands including the thyroid, pancreas, breast morphological and radiological images 8/16 (50%). The overall total marks obtained by Google Bard in various OSPE figures, scans, and image identification questions were 34/60 (56.7%). CONCLUSION: Google Bard scored satisfactorily in morphological, histopathological, and radiological image identifications and their interpretations. Google Bard may assist medical students, faculty in medical education and physicians in healthcare settings.


Assuntos
Inteligência Artificial , Humanos , Educação Médica/métodos , Avaliação Educacional/métodos , Radiografia/métodos
2.
Jt Dis Relat Surg ; 35(2): 324-329, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38727111

RESUMO

OBJECTIVES: This study aims to evaluate the inter-observer reliability of fibula-condyle-patella angle measurements and to compare it with other measurement techniques. PATIENTS AND METHODS: Between January 01, 2023 and January 31, 2023, a total of 108 patients (20 males, 88 females; mean age: 47.5±12.0 years; range, 18 to 72 years) who underwent X-rays using the fibula-condyle-patella angle, Insall-Salvati, Caton-Deschamps, Blackburne-Pell, and plateau-patella angle (PPA) methods were retrospectively analyzed. Knee lateral radiographs taken in at least 30 degrees of flexion and appropriate rotation were scanned. All measurements were made by two orthopedic surgeons who were blinded to measurement methods. RESULTS: Right knee patellar height measurements were conducted in 56 patients, while left knee patellar heights were assessed in 52 patients. The highest inter-observer concordance was found in the fibula-condyle-patella angle. The second highest concordance was found in the Insall-Salvati. The highest concordance correlation was found with PPA in the measurements of both researchers. CONCLUSION: The fibula-condyle-patella angle is a reliable technique with a good inter-observer reliability for measuring patellar height. We believe that this study will inspire future research to establish comprehensive reference values for clinical applications.


Assuntos
Fíbula , Variações Dependentes do Observador , Patela , Humanos , Feminino , Masculino , Fíbula/diagnóstico por imagem , Fíbula/anatomia & histologia , Adulto , Patela/diagnóstico por imagem , Patela/anatomia & histologia , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Adolescente , Adulto Jovem , Reprodutibilidade dos Testes , Radiografia/métodos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/anatomia & histologia
3.
Semin Musculoskelet Radiol ; 28(3): 327-336, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38768597

RESUMO

Knee pain is one of the most common indications for radiography in the evaluation of musculoskeletal disorders in children and adolescents. According to international guidelines, knee radiographs should be obtained when there is the suspicion of an effusion, limited motion, pain to palpation, inability to bear weight, mechanical symptoms (such as "locking"), and persistent knee pain after therapy. When indicated, radiographs can provide crucial information for the clinical decision-making process. Because of the developmental changes occurring in the knee during growth, the assessment of knee radiographs can be challenging in children and adolescents. Radiologists unfamiliar with the appearance of the knee on radiographs during skeletal maturation risk overcalling or overlooking bone lesions. Image acquisition techniques and parameters should be adapted to children. This article describes the most common challenges in distinguishing pathology from the normal appearance of knee radiographs in the pediatric population, offering some pearls and pitfalls that can be useful in clinical practice.


Assuntos
Articulação do Joelho , Humanos , Criança , Articulação do Joelho/diagnóstico por imagem , Adolescente , Radiografia/métodos , Artropatias/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Diagnóstico Diferencial
4.
Med Eng Phys ; 127: 104167, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38692766

RESUMO

BACKGROUND: Recent studies have stated the relevance of having new parameters to quantify the position and orientation of the scapula with patients standing upright. Although biplanar radiography can provide 3D reconstructions of the scapula and the spine, it is not yet possible to acquire these images with patients in the same position. METHODS: Two pairs of images were acquired, one for the 3D reconstruction of the spine and ribcage and one for the 3D reconstruction of the scapula. Following 3D reconstructions, scapular alignment was performed in two stages, a coarse alignment based on manual annotations of landmarks on the clavicle and pelvis, and an adjusted alignment. Clinical parameters were computed: protraction, internal rotation, tilt and upward rotation. Reproducibility was assessed on an in vivo dataset of upright biplanar radiographs. Accuracy was assessed using supine cadaveric CT-scans and digitally reconstructed radiographs. FINDINGS: The mean error was less than 2° for all clinical parameters, and the 95 % confidence interval for reproducibility ranged from 2.5° to 5.3°. INTERPRETATION: The confidence intervals were lower than the variability measured between participants for the clinical parameters assessed, which indicates that this method has the potential to detect different patterns in pathological populations.


Assuntos
Imageamento Tridimensional , Postura , Escápula , Escápula/diagnóstico por imagem , Humanos , Masculino , Feminino , Adulto , Reprodutibilidade dos Testes , Radiografia/métodos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Idoso
5.
Sci Rep ; 14(1): 10342, 2024 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-38710901

RESUMO

To compare the demographic, clinical, and laboratory characteristics, disease onset, and clinical features of radiographic axial Spondyloarthritis (r-axSpA) and non-radiographic axial Spondyloarthritis (nr-axSpA) patients. All patients who attended outpatient spondylarthritis (SpA) clinics at Hospital General de Mexico and the Instituto Nacional de la Nutrición from 1998 to 2005 and met the rheumatologist diagnostic criteria for SpA were selected. Then the SpA patients were classified by European Spondyloarthropathy Study Group criteria (ESSG). We selected SpA patients with axial presentation as axial SpA (axSpA), and they were classified as r-axSpA if they met modified New York (mNY) criteria for sacroiliitis and as nr-axSpA if they did not meet mNY criteria; to compared clinical, demographic, and laboratory test between the subgroups. It included 148 SpA patients; 55 (37.2%) patients had r-axSpA, and 70 (47.3%) had nr-axSpA. The nr-axSpA patients had a lower proportion of males (58.6% vs 78.2%, P < 0.05), lower HLA-B27 frequency (54.3%. vs. 92.7%, P < 0.05), were older at disease onset (21 vs 16 years; P < 0.01) and had a higher frequency of infections at disease onset (9.1% vs 32.9, P < 0.05) than r-axSpA. BASFI (2.9 vs 4.8; P < 0.0001), Dougados functional index (7 vs. 14; P < 0.05), and BASDAI (4.1 vs. 5.2; P < 0.001) were lower in patients with nr-axSpA than r-axSpA, respectively. The factors that most influenced the presentation of r-axSpA were history of uveitis (OR 14, 95% CI 2.3-85), HLA-B27 (OR 7.97, 95% CI, 2.96-122), male sex (OR 6.16, 95% CI, 1.47-25.7), axial enthesopathy count (OR 1.17 95% CI, 1.03-1.33). This study provides insight into the differences between nr-axSpA and r-axSpA in Mexico. Patients with r-axSpA were mainly male, with a younger presentation age, a higher prevalence of HLA-B27, more history of uveitis, fewer episodes of dactylitis, more axial enthesopathy, and higher disease activity than nr-axSpA.


Assuntos
Espondiloartrite Axial , Humanos , Masculino , México/epidemiologia , Feminino , Adulto , Espondiloartrite Axial/diagnóstico por imagem , Antígeno HLA-B27 , Radiografia/métodos , Pessoa de Meia-Idade , Estudos de Coortes , Adulto Jovem , Espondilartrite/diagnóstico por imagem
6.
J Pak Med Assoc ; 74(4): 791-793, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38751281

RESUMO

The nasopharynx is a rare anatomical location where a foreign body may become lodged after being ingested or inhaled. We are presenting a rare case of nasopharyngeal foreign body impaction in a two-and-a-half-year-old child that had been missed for almost a year. The child presented with a history of right-sided foul-smelling nasal discharge, snoring and mouth breathing. An X-Ray soft tissue lateral view of the post-nasal space showed an irregular partially radiopaque nasopharyngeal foreign body. The removal of the foreign body was performed under general anaesthesia successfully. Foreign body impaction in the nasopharynx can easily be missed and it is important to keep this region in mind when dealing with missing inhaled or ingested foreign bodies.


Assuntos
Corpos Estranhos , Nasofaringe , Humanos , Corpos Estranhos/cirurgia , Corpos Estranhos/diagnóstico por imagem , Nasofaringe/diagnóstico por imagem , Pré-Escolar , Masculino , Radiografia/métodos
8.
Ortop Traumatol Rehabil ; 26(1): 347-355, 2024 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-38646904

RESUMO

BACKGROUND: Radial neck fractures account for 5-17% of elbow fractures and about 1% of all fractures in children. The subject of the presented research is assesment of clinical and radiological outcomes of the Metaizeau technique for treatment of isolated radial neck fractures in children. MATERIAL AND METHODS: Retrospective analysis of clinical and radiological data of patients treated with the Metaizeau technique in our Department between 2015 and 2020. Twenty children with isolated radial neck fracture met the inclusion criteria. RESULTS: Excellent outcomes of operative treatment were achieved in 95% of children. None of the complications described in the literature (e.g. avascular necrosis of radial head (AVN), malunion, nonunion) were observed in our case series. CONLCUSIONS: 1. The Metaizeau technique for reduction and stabilisation of the radial neck fracture using a TEN is a safe and effective method in the paediatric population and produces good clinical and radiological results. 2.Furthermore, the minimal demands it places on surgical equipment make it possible for this technique to be recommended to orthopaedic surgeons managing paediatric trauma patients.


Assuntos
Fixação Interna de Fraturas , Fraturas do Rádio , Humanos , Fraturas do Rádio/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Masculino , Feminino , Criança , Estudos Retrospectivos , Fixação Interna de Fraturas/métodos , Resultado do Tratamento , Estudos de Casos e Controles , Adolescente , Pré-Escolar , Radiografia/métodos , Fraturas da Cabeça e do Colo do Rádio
9.
Int Orthop ; 48(6): 1427-1438, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38558191

RESUMO

PURPOSE: To present the technique of correction of multiplanar deformities around the knee in children and adolescents using the monolateral external fixator. Also, to evaluate the results of the technique regarding radiological correction, time to union, and possible complications. METHODS: A total of 29 patients (47 limbs) were prospectively included in the study (14 males and 15 females). Their median age was 13 years (range, 7-17). All patients had at least a 2-plane deformity around the knee which was corrected using a monolateral external fixator. The primary outcome measure was deformity correction (correction of mechanical axis deviation (MAD) in both the coronal and sagittal planes with correction of rotational deformities). The secondary outcome measures included bony union, radiographic, and functional results (assessed by using the Association for the Study and Application of the Method of Ilizarov (ASAMI) score). RESULTS: The median pre-operative MAD improved from 6.3 to 0.4 cm post-operatively. According to the ASAMI scoring system, the radiographic scoring was excellent in all cases (100%), and the functional scoring was excellent in 22 cases (89.7%) and good in three cases (10.3%). CONCLUSION: The simple monolateral fixator can be an effective tool for multiplanar correction of complex deformities around the knee without limb length discrepancy.


Assuntos
Fixadores Externos , Articulação do Joelho , Humanos , Adolescente , Feminino , Criança , Masculino , Articulação do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/anormalidades , Estudos Prospectivos , Radiografia/métodos , Resultado do Tratamento , Técnica de Ilizarov/instrumentação
11.
Sci Rep ; 14(1): 9393, 2024 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-38658644

RESUMO

Osteophytes are frequently observed in elderly people and most commonly appear at the anterior edge of the cervical and lumbar vertebrae body. The anterior osteophytes keep developing and will lead to neck/back pain over time. In clinical practice, the accurate measurement of the anterior osteophyte length and the understanding of the temporal progression of anterior osteophyte growth are of vital importance to clinicians for effective treatment planning. This study proposes a new measuring method using the osteophyte ratio index to quantify anterior osteophyte length based on lateral radiographs. Moreover, we develop a continuous stochastic degradation model with time-related functions to characterize the anterior osteophyte formation and growth process on cervical and lumbar vertebrae over time. Follow-up data of anterior osteophytes up to 9 years are obtained for measurement and model validation. The agreement test indicates excellent reproducibility for our measuring method. The proposed model accurately fits the osteophyte growth paths. The model predicts the mean time to onset of pain and obtained survival function of the degenerative vertebrae. This research opens the door to future quantification and mathematical modeling of the anterior osteophyte growth on human cervical and lumbar vertebrae. The measured follow-up data is shared for future studies.


Assuntos
Vértebras Cervicais , Vértebras Lombares , Osteófito , Radiografia , Humanos , Osteófito/diagnóstico por imagem , Osteófito/patologia , Seguimentos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Radiografia/métodos , Feminino , Masculino , Idoso , Processos Estocásticos , Pessoa de Meia-Idade
12.
Acta Orthop Belg ; 90(1): 41-45, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38669647

RESUMO

Hip resurfacing arthroplasty (HRA) has been advocated as an attractive therapy for a younger, more demanding patient population with debilitating hip osteoarthritis. Controversies surrounding metal-on-metal (MoM) hip resurfacing have, however, led to a significant decline in the popularity of the HRA. Despite this, substantial evidence supports the use of specific implants in a selected group of patients. This is a continued retrospective analysis of a single surgeon series of the Birmingham Hip Resurfacing (BHR). Initial medium-term analysis was done in 2011 and published by Van der Bracht et al.13. This analysis includes a long-term follow-up of 7 to 12 years, including functional scoring (HHS, HOOS and UCLA activity score), metal ion evaluation and survival analysis. Failure was defined as revision for any cause. A total of 267 resurfacing procedures with the BHR were included in 247 patients. We had a mean follow-up of 8.3 years. Overall survival at ten years was 94.8%(97.2% for males and 90.1% for females). There was a statistically significant increase in mean HHS score at follow-up (56.03 - IQR 47-65 to 96.07 - IQR 96-100). Elevated metal ions were correlated with a statistically significant increase in the probability of complications. This cohort study further proved that hip resurfacing arthroplasty with the Birmingham Hip Resurfacing implant provides a good alternative to conventional total hip arthroplasty in young patients. There was a significant increase in functional scores at follow-up. There is further evidence of less favorable outcomes in female patients.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Osteoartrite do Quadril , Humanos , Feminino , Artroplastia de Quadril/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Seguimentos , Osteoartrite do Quadril/cirurgia , Adulto , Próteses Articulares Metal-Metal , Falha de Prótese , Desenho de Prótese , Idoso , Reoperação/estatística & dados numéricos , Radiografia/métodos , Resultado do Tratamento
13.
Acta Orthop Belg ; 90(1): 57-62, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38669650

RESUMO

Acromioclavicular joint (ACJ) reconstruction using artificial ligaments is a common surgical treatment for Rockwood grade III or higher injuries. These techniques use bone tunnels in the clavicle and coracoid to insert the Tightrope implants. This multicenter retrospective study compares long term radiographic follow up of clavicular tunnel widening in two groups of patients with high-grade ACJ injury who underwent reconstruction using two different surgical techniques. The first group of 23 patients underwent an arthroscopic single clavicular tunnel ACJ reconstruction. The second group of 23 patiënts underwent an open double clavicular tunnel reconstruction. Inclusion criteria are Rockwood grade III or higher injury and minimum 18 months of follow-up. Exclusion criteria are distal clavicle fracture and additional stabilization techniques. Radiographic results were measured on anteroposterior shoulder radiographs taken at the first and last follow-up. Clavicular tunnel widening is the main outcome measurement. Secondary outcomes are heterotopic ligament calcifications, migration of buttons, tunnel fracture and loss of acromioclavicular reduction. The mean clavicular tunnel widening in the single clavicular tunnel technique is 1.91 mm. In the double clavicular tunnel technique, the widening of the medial tunnel is 2.52 mm and 3.59 mm in the lateral tunnel. The difference in widening between the single tunnel and the lateral tunnel is significant (p=0.003). A very clear observation on all follow-up X-rays was a reorientation of the clavicular tunnels towards the coracoid. The double clavicular tunnel technique has more tunnel widening in both tunnels compared to the single bundle technique.


Assuntos
Articulação Acromioclavicular , Clavícula , Humanos , Articulação Acromioclavicular/cirurgia , Articulação Acromioclavicular/lesões , Articulação Acromioclavicular/diagnóstico por imagem , Clavícula/cirurgia , Clavícula/lesões , Clavícula/diagnóstico por imagem , Estudos Retrospectivos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Artroscopia/métodos , Radiografia/métodos
14.
Medicina (Kaunas) ; 60(4)2024 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-38674191

RESUMO

There is currently no consensus on the optimal placement of the tibial tunnel for double-bundle posterior cruciate ligament (PCL) reconstruction. The purpose of this study was to compare the clinical and radiologic outcomes of double-bundle PCL reconstruction utilizing anatomic versus low tibial tunnels. We conducted a retrospective cohort study involving patients who underwent double-bundle PCL reconstruction between Jan 2019 and Jan 2022, with a minimum follow-up of 2 years (n = 36). Based on the tibial tunnel position on postoperative computed tomography, patients were categorized into two groups: anatomic placement (group A; n = 18) and low tunnel placement (group L; n = 18). We compared the range of motion, stability test, complications, and side-to-side differences in tibial posterior translation using kneeling stress radiography between the two groups. There were no significant differences between the groups regarding clinical outcomes or complication rates. No significant differences in the posterior drawer test and side-to-side difference on kneeling stress radiography (2.5 ± 1.2 mm in group A vs. 3.7 ± 2.0 mm in group L; p = 0.346). In conclusion, the main findings of this study indicate that both anatomic tunnel and low tibial tunnel placements in double-bundle PCL reconstruction demonstrated comparable and satisfactory clinical and radiologic outcomes, with similar overall complication rates at the 2-year follow-up.


Assuntos
Reconstrução do Ligamento Cruzado Posterior , Tíbia , Humanos , Masculino , Feminino , Estudos Retrospectivos , Adulto , Tíbia/cirurgia , Tíbia/diagnóstico por imagem , Seguimentos , Reconstrução do Ligamento Cruzado Posterior/métodos , Amplitude de Movimento Articular , Pessoa de Meia-Idade , Resultado do Tratamento , Ligamento Cruzado Posterior/cirurgia , Ligamento Cruzado Posterior/lesões , Tomografia Computadorizada por Raios X/métodos , Estudos de Coortes , Radiografia/métodos
15.
Int Orthop ; 48(6): 1453-1461, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38580779

RESUMO

PURPOSE: To evaluate the functional and cosmetic effects of elbow supracondylar fractures (SCF) in children with residual rotational deformity. METHODS: Retrospective review cohort of patients with evidence of malrotation after treatment for SCF. An analysis of the postoperative X-ray of 305 consecutive SCF type 3 treated surgically during five years identified 46 elbows with rotational deformity that fulfilled the selection criteria and were recalled for review; only 27 patients agreed to participate. Patients were evaluated clinically and radiographically. Clinically, the elbow and shoulder ROM were assessed. The postoperative fracture rotation (PFR) was radiologically measured using the Berdis method. Results were categorized according to Flynn criteria, and functional outcomes were evaluated with the QuickDASH questionnaire. On final assessment, a radiograph of both elbows was obtained, and measures were compared. Descriptive analysis was made calculating median, range, proportions, and confidence intervals. Non-parametric tests were used to test the association between variables. RESULTS: The group had a median age of four years and a median follow-up of 52 months. Shoulder rotation was asymmetrical in 13 patients; six patients presented a change on carrying angle > 5° (4 varus/2 valgus). The higher the residual rotation, the higher the chances of an altered shoulder rotation (for each degree of PFR, the shoulder rotation was changed to 0.4°). However, there was a low correlation between the amount of rotation and the final carrying angle (r = 0.37). According to Flynn's criteria, over 95% had excellent or good results. CONCLUSION: There was a weak correlation between varus and rotational malalignment. Patients with moderate residual malrotation could be expected to have a good outcome even if some shoulder rotation changes persist.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Amplitude de Movimento Articular , Humanos , Masculino , Estudos Retrospectivos , Feminino , Criança , Pré-Escolar , Amplitude de Movimento Articular/fisiologia , Fraturas do Úmero/cirurgia , Articulação do Cotovelo/cirurgia , Articulação do Cotovelo/fisiopatologia , Radiografia/métodos , Lesões no Cotovelo , Resultado do Tratamento , Rotação , Adolescente , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/efeitos adversos
16.
Bone ; 184: 117107, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38677502

RESUMO

Osteoporosis is a common condition that can lead to fractures, mobility issues, and death. Although dual-energy X-ray absorptiometry (DXA) is the gold standard for osteoporosis, it is expensive and not widely available. In contrast, kidney-ureter-bladder (KUB) radiographs are inexpensive and frequently ordered in clinical practice. Thus, it is a potential screening tool for osteoporosis. In this study, we explored the possibility of predicting the bone mineral density (BMD) and classifying high-risk patient groups using KUB radiographs. We proposed DeepDXA-KUB, a deep learning model that predicts the BMD values of the left hip and lumbar vertebrae from an input KUB image. The datasets were obtained from Taiwanese medical centers between 2006 and 2019, using 8913 pairs of KUB radiographs and DXA examinations performed within 6 months. The images were randomly divided into training and validation sets in a 4:1 ratio. To evaluate the model's performance, we computed a confusion matrix and evaluated the sensitivity, specificity, accuracy, precision, positive predictive value, negative predictive value, F1 score, and area under the receiver operating curve (AUROC). Moderate correlations were observed between the predicted and DXA-measured BMD values, with a correlation coefficient of 0.858 for the lumbar vertebrae and 0.87 for the left hip. The model demonstrated an osteoporosis detection accuracy, sensitivity, and specificity of 84.7 %, 81.6 %, and 86.6 % for the lumbar vertebrae and 84.2 %, 91.2 %, and 81 % for the left hip, respectively. The AUROC was 0.939 for the lumbar vertebrae and 0.947 for the left hip, indicating a satisfactory performance in osteoporosis screening. The present study is the first to develop a deep learning model based on KUB radiographs to predict lumbar spine and femoral BMD. Our model demonstrated a promising correlation between the predicted and DXA-measured BMD in both the lumbar vertebrae and hip, showing great potential for the opportunistic screening of osteoporosis.


Assuntos
Densidade Óssea , Redes Neurais de Computação , Osteoporose , Humanos , Osteoporose/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Rim/diagnóstico por imagem , Absorciometria de Fóton/métodos , Bexiga Urinária/diagnóstico por imagem , Radiografia/métodos , Aprendizado Profundo , Vértebras Lombares/diagnóstico por imagem , Adulto , Curva ROC
17.
Eur J Orthop Surg Traumatol ; 34(4): 2129-2136, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38557890

RESUMO

INTRODUCTION: Accurate reconstruction of hip anatomy and biomechanics is mandatory for achieving good clinical outcomes following total hip replacement (THR). Optimal stem alignment is essential to avoid impingement or loosening. This study aimed to evaluate sagittal stem position following cementless THR and its relationship with patient's functional outcome and post-operative radiological parameters. METHOD: We performed analytical observational study with cross-sectional design on 71 hips (67 patients, ranged 18-85 years old) that underwent primary cementless THR in two orthopedic centers in Jakarta, Indonesia. All hips were operated through either anterolateral or posterior approach using either extended/full-coating wedge-tapered stem or proximal-coated wedge-tapered stem. Clinical outcomes were evaluated at follow-up time using mHHS questionnaire, VAS level of thigh pain, and hip ROM. Stem sagittal alignment and other radiological parameters, including combined anteversion and offset, were measured from conventional radiograph. RESULTS: There were no significant differences on mHHS score, VAS level on thigh pain, and ROM between stem alignment groups. Post-operative anteversion and offset of the implant were not affected by the stem sagittal position. All influencing factors have significant effect on sagittal stem alignment. Linear regression test on femur morphology showed 0.69° increase in stem posterior tilt for every 1° increase in the anterior bowing (coeff. = 0.502). CONCLUSION: Stem tilting in sagittal plane did not affect patient's functional outcome or post-operative radiological parameters. In addition, for every degree of increased anterior femoral bowing, 0.69° increase in posterior stem tilting can be expected.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Radiografia , Humanos , Artroplastia de Quadril/métodos , Artroplastia de Quadril/efeitos adversos , Pessoa de Meia-Idade , Masculino , Feminino , Idoso , Adulto , Estudos Transversais , Idoso de 80 Anos ou mais , Adulto Jovem , Radiografia/métodos , Adolescente , Amplitude de Movimento Articular , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Resultado do Tratamento , Desenho de Prótese
18.
Eur J Orthop Surg Traumatol ; 34(4): 2185-2191, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38573382

RESUMO

PURPOSE: The indication for unicompartmental knee arthroplasty (UKA) has been extended to cases with some degree of preoperative knee flexion contracture recently. The purpose of this study was to clarify the effect of flexion contracture on component angles. MATERIALS AND METHODS: Thirty-five fixed-bearing UKAs using the spacer block technique with preoperative flexion contracture (Group FC) and 35 UKAs using the same technique without preoperative flexion contracture (Group NC) were included. Using radiographs, the coronal femoral component angle, coronal tibial component angle, sagittal femoral component angle, and sagittal tibial component angle were determined. Also, extension and flexion angles of the knee as well as coronal Hip-Knee-Ankle (HKA) angles in long-leg standing radiographs were measured. The data about the thickness of the selected insert were also collected. The above results were compared between the two groups. RESULTS: The femoral component tended to be placed in a more varus and flexed position in Group FC, while no significant difference was found about the tibial component angles. While there was no significant difference in pre- and postoperative knee flexion angles between the two groups, flexion contracture remained postoperatively in Group FC. Preoperative HKA angle was greater in Group FC while the difference was no longer significant postoperatively. Regarding the thickness of the selected insert, thicker inserts tended to be used in Group FC. CONCLUSIONS: In fixed-bearing UKA with the spacer block technique, the femoral component tended to be placed in a flexed and varus position in the knees with preoperative flexion contracture.


Assuntos
Artroplastia do Joelho , Contratura , Articulação do Joelho , Amplitude de Movimento Articular , Humanos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/efeitos adversos , Feminino , Contratura/etiologia , Contratura/fisiopatologia , Contratura/cirurgia , Contratura/diagnóstico por imagem , Masculino , Idoso , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/fisiopatologia , Período Pré-Operatório
19.
Arch Orthop Trauma Surg ; 144(5): 2461-2467, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38578309

RESUMO

Distal radius fractures rank among the most prevalent fractures in humans, necessitating accurate radiological imaging and interpretation for optimal diagnosis and treatment. In addition to human radiologists, artificial intelligence systems are increasingly employed for radiological assessments. Since 2023, ChatGPT 4 has offered image analysis capabilities, which can also be used for the analysis of wrist radiographs. This study evaluates the diagnostic power of ChatGPT 4 in identifying distal radius fractures, comparing it with a board-certified radiologist, a hand surgery resident, a medical student, and the well-established AI Gleamer BoneView™. Results demonstrate ChatGPT 4's good diagnostic accuracy (sensitivity 0.88, specificity 0.98, diagnostic power (AUC) 0.93), surpassing the medical student (sensitivity 0.98, specificity 0.72, diagnostic power (AUC) 0.85; p = 0.04) significantly. Nevertheless, the diagnostic power of ChatGPT 4 lags behind the hand surgery resident (sensitivity 0.99, specificity 0.98, diagnostic power (AUC) 0.985; p = 0.014) and Gleamer BoneView™(sensitivity 1.00, specificity 0.98, diagnostic power (AUC) 0.99; p = 0.006). This study highlights the utility and potential applications of artificial intelligence in modern medicine, emphasizing ChatGPT 4 as a valuable tool for enhancing diagnostic capabilities in the field of medical imaging.


Assuntos
Fraturas do Rádio , Humanos , Fraturas do Rádio/diagnóstico por imagem , Radiografia/métodos , Inteligência Artificial , Sensibilidade e Especificidade , Feminino , Masculino , Pessoa de Meia-Idade , Traumatismos do Punho/diagnóstico por imagem , Idoso , Adulto , Fraturas do Punho
20.
Radiology ; 311(1): e231055, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38687217

RESUMO

Background Commonly used pediatric lower extremity growth standards are based on small, dated data sets. Artificial intelligence (AI) enables creation of updated growth standards. Purpose To train an AI model using standing slot-scanning radiographs in a racially diverse data set of pediatric patients to measure lower extremity length and to compare expected growth curves derived using AI measurements to those of the conventional Anderson-Green method. Materials and Methods This retrospective study included pediatric patients aged 0-21 years who underwent at least two slot-scanning radiographs in routine clinical care between August 2015 and February 2022. A Mask Region-based Convolutional Neural Network was trained to segment the femur and tibia on radiographs and measure total leg, femoral, and tibial length; accuracy was assessed with mean absolute error. AI measurements were used to create quantile polynomial regression femoral and tibial growth curves, which were compared with the growth curves of the Anderson-Green method for coverage based on the central 90% of the estimated growth distribution. Results In total, 1874 examinations in 523 patients (mean age, 12.7 years ± 2.8 [SD]; 349 female patients) were included; 40% of patients self-identified as White and not Hispanic or Latino, and the remaining 60% self-identified as belonging to a different racial or ethnic group. The AI measurement training, validation, and internal test sets included 114, 25, and 64 examinations, respectively. The mean absolute errors of AI measurements of the femur, tibia, and lower extremity in the test data set were 0.25, 0.27, and 0.33 cm, respectively. All 1874 examinations were used to generate growth curves. AI growth curves more accurately represented lower extremity growth in an external test set (n = 154 examinations) than the Anderson-Green method (90% coverage probability: 86.7% [95% CI: 82.9, 90.5] for AI model vs 73.4% [95% CI: 68.4, 78.3] for Anderson-Green method; χ2 test, P < .001). Conclusion Lower extremity growth curves derived from AI measurements on standing slot-scanning radiographs from a diverse pediatric data set enabled more accurate prediction of pediatric growth. © RSNA, 2024 Supplemental material is available for this article.


Assuntos
Inteligência Artificial , Fêmur , Tíbia , Humanos , Criança , Feminino , Adolescente , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Masculino , Pré-Escolar , Fêmur/diagnóstico por imagem , Lactente , Adulto Jovem , Recém-Nascido , Radiografia/métodos , Extremidade Inferior/diagnóstico por imagem
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