Ultrasound-guided percutaneous needle tenotomy using Tenex system for refractory lateral epicondylitis; short and long-term effectiveness and contributing factors.

BACKGROUND: Ultrasound-guided percutaneous needle tenotomy (USPNT) has been proposed as an alternative treatment to surgical intervention for lateral epicondylitis (LE). The Tenex system (Tenex Health Inc., Lake Forest, CA, USA) for USPNT is an ultrasonic device involving a needle which oscillates at high frequency to debride and aspirate diseased tendon under ultrasound image guidance. This investigation evaluates the efficacy of USPNT using the Tenex system for LE refractory to conservative management. We also seek to evaluate patient-specific factors which may correlate with treatment response. MATERIALS AND METHODS: PRTEE (Patient-Rated Tennis Elbow Evaluation) and DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaires were completed before performing the Tenex USPNT for all consecutive patients over a course of 38 months (Feb 2015-Mar 2018). Patients were contacted for follow-up evaluations. Paired t test was used to evaluate significant changes in treatment response (p < 0.05). The univariate Tobit regression model was applied followed by multivariate Tobit model with forward selection algorithm. All models were adjusted by preoperative score and follow-up duration. RESULTS: A total of 37 patients (average age 51± 9 years, M/F:15/22) with refractory LE were included (mean follow-up, 531 days; range, 65-1148 days). Tenex USPNT significantly improved PRTEE and DASH scores (p < 0.001). In some patients, this decrease persisted for up to 3 years after intervention. A significant association between treatment response and post-procedure physical therapy (PT) was present. Post-procedure PT contributes to 60, 68, 59, and 50% of reduction in PRTEE pain, function, total scores, and DASH score, respectively (p < 0.001). No tendon ruptures, post-procedural infections, or other complications were noted. CONCLUSION: USPNT with Tenex significantly improves symptoms and function in individuals with LE even with long-term follow-up for 3 years. Post-procedure PT is associated with improved treatment response and should be considered after USPNT.

High-Resolution MR Imaging and US Anatomy of the Thumb.

Despite having many unique anatomic features relative to the other digits, the thumb has received little attention in the radiology literature. The thumb, with its opposable and prehensile abilities, enables fine manual dexterity. However, most radiologists have little familiarity with the structures that allow these dynamic movements, other than their recognition of the role of the ulnar collateral ligament in the setting of gamekeeper injury. High-resolution magnetic resonance (MR) imaging allows optimal assessment of the intricate soft-tissue anatomy of the thumb, which enables thumb flexion, extension, abduction, and adduction. Ultrasonography is a readily available, inexpensive tool that can supplement MR imaging in the evaluation of juxta-articular soft-tissue anatomy. Both imaging modalities are extremely useful for identifying the key ligaments responsible for stabilizing the first carpometacarpal and metacarpophalangeal joints. MR imaging is particularly important in assessment of these ligaments in both normal and trauma settings, which is essential for not only recognizing acute injuries but also becoming familiar with the morphologic variations that are potential pitfalls. To accurately and confidently diagnose abnormalities of these small soft-tissue structures, radiologists must have a clear understanding of the complexities associated with imaging the normal thumb anatomy. ©RSNA, 2016.

Super-High-Frequency Low-Loss Sezawa Mode SAW Devices in a GaN/SiC Platform.

This paper presents a comprehensive study of the performance of Sezawa surface acoustic wave (SAW) devices in SweGaN QuanFINE® ultrathin GaN/SiC platform, reaching frequencies above 14 GHz for the first time. Sezawa mode frequency scaling is achieved due to the elimination of the thick buffer layer typically present in epitaxial GaN technology. Finite element analysis (FEA) is first performed to find the range of frequencies over which the Sezawa mode is supported in the grown structure. Transmission lines and resonance cavities driven with Interdigital Transducers (IDTs) are designed, fabricated, and characterized. Modified Mason circuit models are developed for each class of devices to extract critical performance metrics. We observe a strong correlation between measured and simulated dispersion of the phase velocity (vp) and piezoelectric coupling coefficient (k2). Maximum k2 of 0.61% and frequency-quality factor product (f.Qm) of 6×1012 s-1 are achieved for Sezawa resonators at 11 GHz, with a minimum propagation loss of 0.26 dB/λ for the two-port devices. Sezawa modes are observed at frequencies spanning up to 14.3 GHz, achieving a record high in GaN microelectromechanical systems (MEMS) to the best of the authors' knowledge.

Analysis and Modeling of an 11.8 GHz Fin Resonant Body Transistor in a 14 nm FinFET CMOS Process.

In this work, a compact model is presented for a 14-nm CMOS-based fin resonant body transistor (fRBT) operating at a frequency of 11.8 GHz and targeting radio frequency (RF) generation/filtering for next-generation radio communication, clocking, and sensing applications. Analysis of the phononic dispersion characteristics of the device, which informs the model development, shows the presence of displacement component coupling due to the periodic nature of the back-end-of-line (BEOL) metal phononic crystal (PnC). An eigenfrequency-based extraction process, applicable to resonators based on electrostatic force transduction, has been used to model the resonance cavity. Augmented forms of the Berkeley short channel IGFET model (BSIM)-common multigate (CMG) model for FinFETs are used to model the drive and sense transistors in the fRBT. This model framework allows easy integration with the foundry-supplied process design kits (PDKs) and circuit simulators while being flexible toward change in transduction mechanisms and device architecture. Ultimately, the behavior is validated against RF measured data for the fabricated fRBT device under different operating conditions, leading to the demonstration of the first complete model for this class of resonant device integrated seamlessly in the CMOS stack.

ACR White Paper-Based Comprehensive Dose Reduction Initiative Is Associated With a Reversal of the Upward Trend in Radiation Dose for Chest CT.

PURPOSE: In 2010, the authors' department implemented a comprehensive dose reduction strategy based on the ACR white paper on radiation dose in medicine. The aim of this study was to evaluate the effectiveness of the dose reduction program. METHODS: In total, 1,234 adult chest CT scans from 2007 to 2012 were analyzed retrospectively, with institutional review board approval and a waiver of the requirement for informed consent. The primary outcome was effective dose in millisieverts during the three-year periods before (2007-2009) and after (2010-2012) dose reduction implementation. Dose trends were analyzed by fitted linear modeling. The use and effects on total exposure of dose reduction strategies (high pitch, adaptive statistical iterative reconstruction [ASIR], and low tube voltage) were analyzed. RESULTS: The overall mean dose for chest CT was 7.3 ± 5.1 mSv. The mean dose decreased by 30%, from 9.2 mSv (2007-2009) to 6.5 mSv (2010-2012) (P < .001). From 2007 to 2009, the mean dose increased by 1.2 mSv per year (P < .01). From 2010 to 2012, the mean dose decreased by 1.1 mSv per year (P < 0.01). High-pitch technique, ASIR, and low tube voltage increased significantly after dose reduction implementation. High pitch and ASIR were significantly associated with a reduced dose, whereas the effect of reduced voltage was not significant. CONCLUSIONS: Reductions in radiation exposure from medical imaging rely on ongoing technical developments and consistent, vigilant use of dose reduction strategies. This comprehensive dose reduction strategy significantly reduced radiation exposure from chest CT. Annual increases in radiation dose reversed after the strategy was implemented and continued to decline over the study period.