Intraoperative Handheld Digital X-ray for Assessment of Intracochlear Positioning of Electrode Arrays in Recipients of Cochlear Implants.

Objectives: This study aims to evaluate the practicality of handheld digital X-ray in determining the position of the electrode array following Cochlear implantation (CI). Methods: A retrospective study was conducted involving 11 patients (12 ears) who underwent intraoperative imaging via handheld X-ray (MINE ALNU®, OTOM, Gwangju, South Korea) post-CI between December 2021 and January 2023. Immediate confirmation of the correct electrode array placement in the cochlea was achieved, with subsequent comparisons made to C-arm image and postoperative transorbital view X-ray. Results: Rapid intraoperative imaging was achieved in all instances. The electrode types used included 9 Nucleus slim modiolar electrodes, 1 Nucleus contour electrode, and 2 Medel flex26 electrodes. A malpositioned electrode array was detected in one patient. The handheld digital X-ray also adeptly visualized the electrodes implanted in pediatric patients. Conclusions: The use of intraoperative handheld digital X-ray using MINE ALNU® proves to be a safe, efficient, straightforward, and reliable method for immediate identification of an inserted electrode array. It has potential to replace the traditional C-arm X-ray for verifying electrode positioning in the operating room.

Measurements of the noise power spectrum for digital x-ray imaging devices.

Objective.The noise characteristics of digital x-ray imaging devices are determined by contributions such as photon noise, electronic noise, and fixed pattern noise, and can be evaluated from measuring the noise power spectrum (NPS), which is the power spectral density of the noise. Hence, accurately measuring NPS is important in developing detectors for acquiring low-noise digital x-ray images. To make accurate measurements, it is necessary to understand NPS, identify problems that may arise, and know how to process the obtained x-ray images.Approach.The primitive concept of NPS is first introduced with a periodogram-based estimate and its bias and variance are discussed. In measuring NPS based on the IEC62220 standards, various issues, such as the fixed pattern noise, high-precision estimates, and lag corrections, are summarized with simulation examples.Main results.High-precision estimates can be provided for an appropriate number of samples extracted from x-ray images while compromising spectral resolution. Depending on medical imaging systems, by eliminating the influence of fixed pattern noise, NPS, which represents only photon and electronic noise, can be efficiently measured. For NPS measurements in dynamic detectors, an appropriate lag correction technique can be selected depending on the emitted x-rays and image acquisition process.Significance.Various issues in measuring NPS are reviewed and summarized for accurately evaluating the noise performance of digital x-ray imaging devices.

Improving TB control: efficiencies of case-finding interventions in Nigeria.

SETTING: KNCV Nigeria implements seven key TB case-finding interventions. It was critical to evaluate the efficiency of these interventions in terms of TB yield to direct future prioritisation in the country. OBJECTIVES: To compare the efficiency of active case-finding (ACF) interventions for TB in Nigeria. DESIGN: Data from the 2020-2022 implementing period were analysed retrospectively. Intervention efficiencies were analysed using the number needed to screen (NNS), the number needed to test (NNT) and the true screen-positive (TSP) rate. RESULTS: Across the interventions, 21,704,669 persons were screened for TB, 1,834,447 (8.5%) were presumed to have TB (7.7% pre-diagnostic drop-out rate) and 122,452 were diagnosed with TB (TSP rate of 7.2%). The average TSP rate of interventions that used both the WHO four-symptom screen (W4SS) and portable digital X-ray (PDX) screening algorithm was significantly higher (22.6%) than those that employed the former alone (7.0%; OR 3.9, 95% CI 3.74-3.98; P < 0.001). The average NNT for interventions with W4SS/PDX screening was 4 (range: 4-5), while that of W4SS-only screening was 14 (range: 11-22). CONCLUSIONS: Interventions using the PDX in addition to W4SS for TB screening were more efficient in terms of TB case yield than interventions that used symptom-based TB screening only.

CONTEXTE: KNCV Nigeria met en œuvre sept interventions clés de recherche de cas de TB. Il était essentiel d'évaluer l'efficacité de ces interventions en termes de rendement de la TB afin d'orienter les priorités futures dans le pays. OBJECTIFS: Comparer l'efficacité des interventions de recherche active de cas (ACF) pour la TB au Nigéria. MÉTHODE: Les données de la période de mise en œuvre 2020­2022 ont été analysées, rétrospectivement. L'efficacité des interventions a été analysée à l'aide du nombre nécessaire pour dépister (NNS), du nombre nécessaire pour tester (NNT) et du taux de vrais dépistages positifs (TSP). RÉSULTATS: Sur l'ensemble des interventions, 21 704 669 personnes ont bénéficié d'un dépistage de la TB, 1 834 447 (8,5%) ont été présumées atteintes de la TB (taux d'abandon pré-diagnostic de 7,7%) et 122 452 ont reçu un diagnostic de TB (taux de TSP de 7,2%). Le taux moyen de TSP des interventions qui utilisaient à la fois le test des quatre symptômes de l'OMS (W4SS) et l'algorithme de dépistage par radiographie numérique portable (PDX) était significativement plus élevé (22,6%) que celles qui utilisaient uniquement le premier (7,0% ; OR 3,9 ; IC 95% 3,74­3,98 ; P < 0,001). Le NNT moyen des interventions avec dépistage W4SS/PDX était de 4 (intervalle : 4­5), tandis que celui du dépistage W4SS seul était de 14 (intervalle : 11­22). CONCLUSIONS: Les interventions utilisant le PDX en plus du W4SS pour le dépistage de la TB ont été plus efficaces en termes de nombre de cas de TB que les interventions utilisant uniquement le dépistage de la TB basé sur les symptômes.

Deep Learning Neural Network Performance on NDT Digital X-ray Radiography Images: Analyzing the Impact of Image Quality Parameters-An Experimental Study.

In response to the growing inspection demand exerted by process automation in component manufacturing, non-destructive testing (NDT) continues to explore automated approaches that utilize deep-learning algorithms for defect identification, including within digital X-ray radiography images. This necessitates a thorough understanding of the implication of image quality parameters on the performance of these deep-learning models. This study investigated the influence of two image-quality parameters, namely signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), on the performance of a U-net deep-learning semantic segmentation model. Input images were acquired with varying combinations of exposure factors, such as kilovoltage, milli-ampere, and exposure time, which altered the resultant radiographic image quality. The data were sorted into five different datasets according to their measured SNR and CNR values. The deep-learning model was trained five distinct times, utilizing a unique dataset for each training session. Training the model with high CNR values yielded an intersection-over-union (IoU) metric of 0.9594 on test data of the same category but dropped to 0.5875 when tested on lower CNR test data. The result of this study emphasizes the importance of achieving a balance in training dataset according to the investigated quality parameters in order to enhance the performance of deep-learning segmentation models for NDT digital X-ray radiography applications.

The Impact of Simulated Bruxism Forces and Surface Aging Treatments on Two Dental Nano-Biocomposites-A Radiographic and Tomographic Analysis.

Background and Objectives: Nowadays, indication of composite materials for various clinical situations has increased significantly. However, in the oral environment, these biomaterials are subjected (abnormal occlusal forces, external bleaching, consumption of carbonated beverages, etc.) to changes in their functional and mechanical behavior when indicated primarily for patients with masticatory habits. The study aimed to recreate in our lab one of the most common situations nowadays-in-office activity of a young patient suffering from specific parafunctional occlusal stress (bruxism) who consumes acidic beverages and is using at-home dental bleaching. Materials and Methods: Sixty standardized class II cavities were restored with two nanohybrid biocomposite materials (Filtek Z550, 3M ESPE, and Evetric, Ivoclar Vivadent); the restored teeth were immersed in sports drinks and carbonated beverages and exposed to an at-home teeth bleaching agent. The samples were subjected to parafunctional mechanical loads using a dual-axis chewing simulator. A grading evaluation system was conducted to assess the defects of the restorations using different examination devices: a CBCT, a high-resolution digital camera, and periapical X-rays. Results: Before mechanical loading, the CBCT analysis revealed substantially fewer interfacial defects between the two resin-based composites (p > 0.05), whereas, after bruxism forces simulation, significantly more defects were identified (p < 0.05). Qualitative examination of the restorations showed more occlusal defects for the Evetric than the other nanohybrid composite. Conclusions: There were different behaviors observed regarding the studied nanocomposites when simulation of parafunctional masticatory forces was associated with aging treatments.

Risk Factors for Failure of Conservative Management of Insertional Achilles Tendinosis.

INTRODUCTION: While many patients benefit from nonoperative treatment of insertional Achilles tendinopathy (IAT), some elect for surgical debridement and reconstruction. The purpose of this study is to determine the relationship of patient demographic characteristics, comorbidity profiles, and radiological parameters with failure of conservative management of IAT. METHODS: A retrospective chart review was performed to identify patients who received either surgical or nonsurgical treatment of IAT at an academic institution from September 2015 to June 2019 (N = 226). Demographic and comorbidity data, and the presence and magnitude of relevant radiological parameters were collected and compared between the surgically (n = 48) and nonsurgically (n = 178) treated groups. RESULTS: No significant differences could be detected between groups regarding demographic factors or previous procedures. The surgery group was significantly more likely to have evidence of Haglund's deformity on clinical exam (83% vs 69%, P = .005), lower SF-12 physical scores (25.5 vs 35.5, P < .001), higher VAS pain scores (6.3 vs 5.3, P = .033), any mental illness (33% vs 20%, P = .044), and depression (27% vs 12%, P = .012). DISCUSSION: Patients who received surgery for IAT were significantly more likely to have evidence of Haglund's deformity on clinical exam, depression, higher VAS pain scores, and lower SF-12 physical scores. Both patients and surgeons should be aware of the higher rates of failure of conservative treatment in these patients. LEVEL OF EVIDENCE: Level III.

Radiological Imaging in Nail Unit Disorders (Part I) - Modalities Used.

The nail unit is a unique skin appendage, capable of mounting only a limited number of reaction patterns to a variety of insults. This makes it difficult to diagnose many nail conditions based on clinical features alone. Thus, diagnostic modalities have an important role to play in nail disorders. Emphasis is placed on non-invasive diagnostic methods, of which, radiological imaging forms an important part; however, it is a field largely under-explored with very few studies and reports available in the literature. This could be due to the problems encountered in nail unit radiology including its small size, complex anatomy, requirement for special high-frequency probes to reliably evaluate superficial structures, and non-familiarity with nail unit radiological features even amongst trained radiologists. Nevertheless, it plays a useful role in diagnosing nail disorders (especially tumors), localizing the changes, exploring differential diagnoses, estimating prognosis, and planning management. This article is aimed at collating scientific data pertaining to various radiological modalities used in the diagnosis of nail diseases. The advantages and limitations of various imaging techniques used for evaluating the nail unit, including digital radiographs, high-frequency ultrasound, ultrasound doppler (USD), computed tomography (CT), and magnetic resonance imaging (MRI), are discussed in the first part. The second part will discuss the features of common and uncommon nail diseases.

Automatic detection and classification of knee osteoarthritis using deep learning approach.

PURPOSE: We developed a tool for locating and grading knee osteoarthritis (OA) from digital X-ray images and illustrate the possibility of deep learning techniques to predict knee OA as per the Kellgren-Lawrence (KL) grading system. The purpose of the project is to see how effectively an artificial intelligence (AI)-based deep learning approach can locate and diagnose the severity of knee OA in digital X-ray images. METHODS: Selection criteria: Patients above 50 years old with OA symptoms (knee joint pain, stiffness, crepitus, and functional limitations) were included in the study. Medical experts excluded patients with post-surgical evaluation, trauma, and infection from the study. We used 3172 Anterior-posterior view knee joint digital X-ray images. We have trained the Faster RCNN architecture to locate the knee joint space width (JSW) region in digital X-ray images and we incorporate ResNet-50 with transfer learning to extract the features. We have used another pre-trained network (AlexNet with transfer learning) for the classification of knee OA severity. We trained the region proposal network (RPN) using manual extract knee area as the ground truth image and the medical experts graded the knee joint digital X-ray images based on the Kellgren-Lawrence score. An X-ray image is an input for the final model, and the output is a Kellgren-Lawrence grading value. RESULTS: The proposed model identified the minimal knee JSW area with a maximum accuracy of 98.516%, and the overall knee OA severity classification accuracy was 98.90%. CONCLUSIONS: Today numerous diagnostic methods are available, but tools are not transparent and automated analysis of OA remains a problem. The performance of the proposed model increases while fine-tuning the network and it is higher than the existing works. We will extend this work to grade OA in MRI data in the future.

[A Challenge of Digitalizing the X-ray Film Image, and the Recent Technical Trends].

Fuji Photo Film (then), a chemical manufacturer that manufactures film, succeeded in digitizing X-ray photographs for the first time in the world, and commercialized Computed Radiography (CR) in 1983. In addition to eliminating darkroom work from X-ray work and improving the efficiency of X-ray work and diagnosis, this CR also played a role in paving the way for networking of image information in hospitals and for computer-added diagnostic support. Nowadays, the mechanism of digital X-rays has been established and is known to many people, but there was no precedent in the latter half of the 1970s when the development of CR was started. In this paper, we will look back on the development process of such CR first, then we will outline the evolution of digital X-ray detectors and image processing technology, and introduce the technology we have challenged to estimate scattered X-rays in the human body.

Comparison of diagnostic accuracy of digital chest X-ray images between PACS and WhatsApp Messenger in resource poor setting.

PURPOSE: Many underserved remote locations without specialists would benefit from the ability to quickly and easily share images of radiographs with trained radiologists using WhatsApp messenger. However, there is limited evidence on the role of WhatsApp messenger for sharing chest x-ray (CXR) images to aid diagnosis and management. The objective of the study was to determine the diagnostic accuracy and inter-observer agreement of WhatsApp messenger images of digital CXR compared to viewing on Picture Archiving and Communication System (PACS) monitor. METHODS: Two pulmonologists reported 400 WhatsApp messenger images of digital CXR each. After a wash period of two weeks, they reviewed the original CXR images on PACS and again reported their findings. Diagnostic agreement was measured using kappa value, diagnostic accuracy was evaluated by sensitivity and specificity. RESULTS: The diagnostic agreement between WhatsApp and PACS images for both the readers was high in case of normal CXR (0.84), Pneumonia (0.85) and Active Koch's (0.79) and Old Koch's (0.71). The inter-observer agreement between two readers on WhatsApp images was good in cases of normal chest x-ray (0.74), Active Koch's (0.61) and Pneumonia (0.74) and low in COPD (0.31) and Pleural Effusion (0.28) and Carcinoma Lung (0.40). In terms of radiological lesion, inter-observer agreement between two readers on WhatsApp images was good in terms of the zonal involvement, moderate in case of infiltrates, consolidation, nodules, and fibrosis, fair in cavity, effusion (0.28) and poor in hilar lymphadenopathy (0.14). The sensitivity in the diagnosis of nodules, effusion and hilar lymphadenopathy was <50% in both the readers. CONCLUSION: CXR transmission via WhatsApp is able to identify clinical findings similar to viewing the same image on a PACS monitor in cases of Pneumonia and normal subjects. Active and old Koch's has good comparability whereas; diagnostic agreement is poor in COPD, cavity, pleural effusion and hilar lymphadenopathy, requiring more caution during interpretation.

Anterior-posterior view by full-body digital X-ray to rule out severe spinal injuries in Polytraumatized patients.

BACKGROUND: Spinal injuries are present in 16-31% of polytraumatized patients. Rapid identification of spinal injuries requiring immobilization or operative treatment is essential. The Lodox-Statscan (LS) has evolved into a promising time-saving diagnostic tool to diagnose life-threatening injuries with an anterior-posterior (AP)-full-body digital X-ray. METHODS: We aimed to analyze the diagnostic accuracy and the interrater reliability of AP-LS to detect spinal injuries in polytraumatized patients. Therefore, within 3 years, AP-LS of polytraumatized patients (ISS ≥ 16) were retrospectively analyzed by three independent observers. The sensitivity and specificity of correct diagnosis with AP-LS compared to CT scan were calculated. The diagnostic accuracy was evaluated by using the area under the ROC (receiver operating characteristic curve) for sensitivity and specificity. Interrater reliability between the three observers was calculated using Fleiss' Kappa. The sensitivity of AP-LS was further analyzed by the severity of spinal injuries. RESULTS: The study group included 320 patients (48.5 years ±19.5, 89 women). On CT scan, 207 patients presented with a spinal injury (65%, total of 332 injuries). AP-LS had a low sensitivity of 9% (31 of 332, range 0-24%) and high specificity of 99% (range 98-100%). The sensitivity was highest for thoracic spinal injuries (14%). The interrater reliability was slight (κ = 0.02; 95% CI: 0.00, 0.03). Potentially unstable spinal injuries were more likely to be detected than stable injuries (sensitivity 18 and 6%, respectively). CONCLUSION: This study demonstrated high specificity with low sensitivity of AP-LS in detecting spinal injuries compared to CT scan. In polytraumatized patients, AP-LS, implemented in the Advanced Trauma Life Support-algorithm, is a helpful tool to diagnose life-threatening injuries. However, if spinal injuries are suspected, performing a full-body CT scan is necessary for correct diagnosis.

Quantifying cortical bone in fragmentary archeological second metacarpals.

OBJECTIVES: Skeletal variation in cortical bone thickness is an indicator of bone quality and health in archeological populations. Second metacarpal radiogrammetry, which measures cortical thickness at the shaft midpoint, is traditionally used to evaluate bone loss in bioarcheological and some clinical contexts. However fragmentary elements are regularly omitted because the midpoint cannot be determined. This methodological limitation reduces sample sizes and biases them against individuals prone to fracture, such as older individuals with low bone mass. This study introduces a new technique for measuring cortical bone in second metacarpals, the "Region of Interest" (ROI) method, which quantifies bone in archeological remains with less-than-ideal preservation while accounting for cortical heterogeneity. MATERIALS AND METHODS: The ROI method was adapted from digital X-ray radiogrammetry (DXR), a clinical method used to estimate bone mineral density, and tested using second metacarpals from Middenbeemster, Netherlands, a 19th century known age and sex skeletal collection. The ROI method quantifies cortical bone area within a 1.9 cm-long, mid-diaphyseal region, standardized for body size differences using total area (CAIROI ). CAIROI values were compared to traditional radiogrammetric cortical indices (CI) to assess the method's ability to identify age-related bone loss. RESULTS: CAIROI values have high intra- and interobserver replicability and are strongly and significantly correlated with CI values for both males (r[n = 39] = 0.906, p = 0.000) and females (r[n = 58] = 0.925, p = 0.000). CONCLUSION: The ROI method complements traditional radiogrammetry analyses and provides a reliable way to quantify cortical bone in incomplete second metacarpals, thereby maximizing sample sizes, allowing patterns in bone acquisition and loss to be more comprehensively depicted in archeological assemblages.

Screening for women with increased risk of fragility fractures in a general female population using digital X-ray radiogrammetry (DXR).

OBJECTIVE: To evaluate the predictive ability of digital X-ray radiogrammetry (DXR) for fracture in women attending general mammography screening. STUDY DESIGN: In a nested case-control study, women aged between 40 and 75 years, who attended the regional mammography screening program, had their bone mass assessed with DXR and provided information regarding clinical risk factors for osteoporosis. Follow-up was done through cross-referencing with National Patient Registers. Associations between DXR, clinical risk factors and fracture risk were examined. Receiver operating characteristics curves for DXR T-score and different fracture types were plotted, and their respective AUC calculated. MAIN OUTCOME MEASURES: Fractures (hip, major osteoporotic and any clinical facture). Fracture diagnoses were retrieved from National Patient Registers. RESULTS: 14,841 women had their bone mass examined in conjunction with mammography. Of these women, 10,967 returned fully completed questionnaires regarding clinical risk factors. In total 605 fractures (including 355 major osteoporotic fractures and 18 hip fractures) occurred during the follow-up period (median follow-up time was 3.3 years). Women with fractures were older and had lower DXR T-score compared with those without. DXR T-score correlated with fracture risk. HR/SD T-score decrease was 2.15 (CI 1.55-3.00) for hip, 1.47 (CI 1.36-1.59) for major osteoporotic and 1.33 (CI 1.26-1.42) for any clinical fracture. The AUCs for the different fracture types were 0.79 (hip), 0.69 (major osteoporotic) and 0.65 (any clinical). CONCLUSIONS: DXR T-score is negatively correlated with risk of fracture in a general female population. This indicates a potential use of DXR in population-based screening for osteoporosis.

Gunshot Wounds to The Hip.

Gunshot wounds to the hip region are likely to cause complex peritrochanteric fracture. The fracture patterns are often highly comminuted and accompanied by injuries to local structures and abdominal viscera. Our case series analyses 25 orthopaedic procedures performed. The overall union rate for primary fixation was 66%. Two patients underwent revision surgery for failed primary fixation. Two cases where fixation had failed were revised to total hip replacement successfully. These types of injuries present a formidable challenge. Preservation of the femoral head should be prioritised to avoid arthroplasty. Long-term follow-up is necessary in assessing the success of these procedures.

Gross Osteology and digital radiography of the common Capybara (Hydrochoerus hydrochaeris), Carl Linnaeus, 1766 for scientific and clinical application / Osteologia bruta e radiografia digital da capivara comum (Hydrochoerus hydrochaeris), Carl Linnaeus, 1766 para aplicação científica e clínica

Being able to study anatomical structures of wildlife species for science and clinical practice is of great importance. We aimed to describe the normal gross osteology of the common adult capybara Hydrochoerus hydrochaeris (Linnaeus, 1766), using macerated bone specimens and high-resolution digital radiography. The complete axial and appendicular skeleton was further compared with previously reported anatomical findings. For this purpose, we used three adult capybara cadavers (two females and one male), with a mean bodyweight of ±50 kg. Some H. hydrochaeris-specific morphological characteristics, especially in the skull region, show evidence of adaptation to aquatic life, such as an elongated head shape, with eyes, ears, and nose, located dorsally, to stay above water. Additionally, the entire bone structure demonstrates the size and weight support of the largest rodent and its adaptation with respect to foraging and locomotion behaviors. As a semi-aquatic herbivore, classified as cursorial (having limbs adapted for running), the authors believe it should be reclassified as cursorial-swimming/diving. Moreover, we argue to consider a differentiation between H. hydrochaeris silvestris to H. hydrochaeris synanthrope, due to substantial weight variation, in some cases > 100%. This inevitably has an impact on the development of bone structure, thus influencing habitual adaptation, and consequently, its clinical implications and animal handling. Radiography exams helped in the identification of bone structures, which otherwise were not observed in anatomical specimens, such as ossa sesamoidea, including the ossiclelunulae. Likewise, the radiographs were particularly helpful in overall better comprehension of the intubation and catheterization procedures. We believe this work can contribute as a reference to anatomical studies for students and professionals acting in clinic, surgery, and research.(AU)

Ser capaz de estudar estruturas anatômicas dos animais da fauna para fins científicos e prática clínica é de grande importância. Objetivamos descrever a osteologia geral normal de capivaras adultas Hydrochoerus hydrochaeris (Linnaeus, 1766), usando amostras de ossos macerados e radiologia digital de alta resolução. O esqueleto axial e apendicular foi posteriormente comparado a achados anatômicos reportados anteriormente. Para esse fim, nós utilizamos de três cadáveres de capivaras adultas (duas fêmeas e um macho) com peso médio de cerca de 50 kg. cada. Algumas características morfológicas de cavidade específicas, especialmente na região do crânio, evidenciam a adaptação à vida aquática, como o formato alongado da cabeça, com olhos, orelhas e nariz localizados dorsalmente, para permanência sobre a água. O completo desenvolvimento morfológico ósseo é evidência de tamanho e suporte de peso do maior roedor, assim como de seus hábitos de alimentação e locomoção, sendo um herbívoro semiaquático, classificado como cursório (tendo membros adaptados à corrida), caso em que os autores acreditam deveria ser reclassificado como cursorial-natação/mergulho. Além disso, argumentamos que deve ser considerada uma diferenciação entre H. hydrochaeris silvestris e H. hydrochaeris sinantropo, devido ao fato da variação substancial de peso, em alguns casos> 100%, inevitavelmente terá um impacto no desenvolvimento da estrutura óssea, influenciando, assim, a adaptação habitual e, consequentemente, suas implicações clínicas e manejo animal. A radiografia auxiliou na correlação e identificação de estruturas ósseas que não observadas em espécimes anatômicos, como o osso sesamóide, incluindo o ossículo lunar. Ademais, as radiografias foram particularmente úteis para uma melhor compreensão geral de procedimentos de intubação e cateterização. Acreditamos que este trabalho possa contribuir como referência de estudos anatômicos para estudantes e profissionais atuantes em clínica, cirurgia e pesquisa.(AU)

Fifth year of a public-private partnership to improve the case detection of tuberculosis in India: A role model for future action?

BACKGROUND: There is limited access to radiology facilities in most parts of India leading to significant under diagnosis and underreporting of smear negative clinically diagnosed tuberculosis (CDTB). Public Private Partnership (PPP) has a lot to contribute towards addressing this gap through providing access to chest x-ray (CXR) in far-off locations. METHOD: Mobile vans equipped with digital CXR equipment and support staff were provided by a Corporate Hospital working closely with government, with scheduled visits to government peripheral health institutes. Patients received upfront CXR and sputum microscopy along with GeneXpert in accordance with the revised TB diagnostic algorithm prescribed by the national program, Following a successful pilot in 2014 in district Rewari, "TB free Haryana" was launched in November 2015 with a phased roll out in 16 districts by 2018. RESULTS: The pilot initiative in 2014 confirmed practical and clinical feasibility and revealed a high rate (30% of people screened) of CDTB i.e. symptomatic cases with radiologic abnormalities compatible with Pulmonary TB. In the first year (2016), 5 districts were covered and a total of 3340 CXRs were carried out. There was an increase in the case notification rates of new CDTB (smear negative) in 2016 compared to 2015 (p = 0.036); yielding an additional 180 cases and an 11.67% increase in case detection. Scale up to a total of 13 and 16 districts took place successfully in 2017 and 2018 respectively; with 6268 CXRs and 8021 CXRs done in the respective years. CONCLUSION: PPP can involve Corporate Hospitals to improve the existing diagnostic infrastructure and provides access to CXR in a not-for-profit sustainable collaboration, with scale-up to the state level; and potential to replicate this initiative in other states.

Can digital X-ray radiogrammetry be an alternative for dual-energy X-ray absorptiometry in the diagnosis of secondary low bone quality in children?

Bone quality in children is generally measured with dual-energy X-ray absorptiometry (DXA). Digital X-ray radiogrammetry (DXR) uses BoneXpert to measure cortical bone quality on hand radiographs. This prospective study compared DXR and DXA results in children with high probability of secondary low bone quality, defined as DXA of the lumbar spine (DXALS) Z-score ≤ - 2.0. One hundred one children underwent both DXA and DXR assessment. DXALSZ-scores were also adjusted for bone age. DXR Z-scores were compared with both DXALSZ-scores, using Pearson correlations, Bland-Altman analysis, and sensitivity-specificity analysis. Mean bone age, DXR, and both DXA Z-scores were significantly impaired. Pearson correlation coefficients were significant between DXR Z-scores and both DXALSZ-scores 0.507-0.564 (p < 0.001). Bland-Altman analysis showed a mean difference of 0.05-0.48 between DXR and both DXA Z-scores and showed more than 90% similarity for both DXALSZ-scores ≤ - 2.0. DXR had a sensitivity of 67-71% and specificity of 77-83% compared to both DXALSZ-scores.Conclusion: DXR correlates well with as well DXALS as bone age-adjusted DXALSZ-scores and shows good agreement with as well DXALS as bone age-adjusted DXALSZ-scores ≤ - 2.0. DXR shows best results when compared with DXALSZ-scores. What is Known: • Digital X-ray radiogrammetry (DXR) may correlate well with dual-energy X-ray absorptiometry (DXA) in pediatric, adolescent, and adult patients. • DXR is a feasible method for assessment of bone quality in children. What is New: • This is the first prospective study in children with suspected secondary low bone quality that illustrates correlation between DXR and bone age-adjusted DXA Z-scores and that shows good agreement between DXR and DXA as bone age-adjusted DXA Z-scores ≤ -2.0. • Our results suggest DXR to be a good alternative for DXA for determining low bone quality.

The Mini C-Arm Sock: A Novel and Simple Technique for Draping to Prevent Contamination and Penetration.

The mini C-arm is frequently used in foot and ankle surgery. However, its continuous manipulation introduces potential means of contaminating the sterile surgical field. A simple and effective draping technique of the mini C-arm is described to minimize risk of contamination and sharps penetration that can damage the C-arm. Levels of Evidence: Level V.

Quantitative X-Ray Imaging of Mouse Bone by Faxitron.

This chapter describes the use of point projection digital microradiography for rapid imaging and quantitation of bone mineral content in mice.

Comparison of clinical and cost-effectiveness of two strategies using mobile digital x-ray to detect pulmonary tuberculosis in rural India.

BACKGROUND: Medanta - The Medicity, a multi-super specialty corporate hospital in Gurugram, Haryana launched a "TB-Free Haryana" Campaign; mobile van equipped with a digital CXR machine to screen patients with presumptive Tuberculosis (TB). OBJECTIVES: In this study, we aimed to assess the (1) yield and cost analysis of two strategies using mobile digital x-ray to detect Pulmonary TB in rural Haryana. METHODS: An observational study was conducted on all individuals screened by either of the two case finding strategies using a mobile x-ray unit (MXU) mounted on a mobile van in District Mewat, Haryana during Jan-March 2016. RESULTS: Strategy 1: Out of 121 smear negative cases, x-rays were suggestive of TB in 39(32%), of which 24 were started on TB treatment. Cost of identifying a smear negative TB was US$ 32. Strategy 2: Out of 596 presumptive TB, chest x-rays were suggestive of TB in 108 (18%), of which 67 were started on TB treatment (56 were smear negative TB). Cost of detecting any case of TB was US$ 08 (1 USD = 64 INR). CONCLUSION: The study reports a new initiative within a PPM model to improve the diagnosis of PTB by filling the gap in the current diagnostic infrastructure. We believe there is potential for replication of strategy 2 model in other states, although further evidence is required.