RESUMEN
OBJECTIVE: In the evolving landscape of medical research and radiology, effective communication of intricate ideas is imperative, with visualizations playing a crucial role. This study explores the transformative potential of ChatGPT4, a powerful Large Language Model (LLM), in automating the creation of schematics and figures for radiology research papers, specifically focusing on its implications for musculoskeletal studies. MATERIALS AND METHODS: Deploying ChatGPT4, the study aimed to assess the model's ability to generate anatomical images of six large joints-shoulder, elbow, wrist, hip, knee, and ankle. Four variations of a text prompt were utilized, to generate a coronal illustration with annotations for each joint. Evaluation parameters included anatomical correctness, correctness of annotations, aesthetic nature of illustrations, usability of figures in research papers, and cost-effectiveness. Four panellists performed the assessment using a 5-point Likert Scale. RESULTS: Overall analysis of the 24 illustrations encompassing the six joints of interest (4 of each) revealed significant limitations in ChatGPT4's performance. The anatomical design ranged from poor to good, all of the illustrations received a below-average rating for annotation, with the majority assessed as poor. All of them ranked below average for usability in research papers. There was good agreement between raters across all domains (ICC = 0.61). CONCLUSION: While LLMs like ChatGPT4 present promising prospects for rapid figure generation, their current capabilities fall short of meeting the rigorous standards demanded by musculoskeletal radiology research. Future developments should focus on iterative refinement processes to enhance the realism of LLM-generated musculoskeletal schematics.
Asunto(s)
Sistema Musculoesquelético , Humanos , Sistema Musculoesquelético/diagnóstico por imagen , Sistema Musculoesquelético/anatomía & histología , Reproducibilidad de los Resultados , Ilustración Médica , Articulaciones/diagnóstico por imagen , Articulaciones/anatomía & histologíaRESUMEN
PURPOSE: The use of artificial intelligence (AI) tools to aid in summarizing information in medicine and research has recently garnered a huge amount of interest. While tools such as ChatGPT produce convincing and naturally sounding output, the answers are sometimes incorrect. Some of these drawbacks, it is hoped, can be avoided by using programmes trained for a more specific scope. In this study we compared the performance of a new AI tool (the-literature.com) to the latest version OpenAI's ChatGPT (GPT-4) in summarizing topics that the authors have significantly contributed to. METHODS: The AI tools were asked to produce a literature review on 7 topics. These were selected based on the research topics that the authors were intimately familiar with and have contributed to through their own publications. The output produced by the AI tools were graded on a 1-5 Likert scale for accuracy, comprehensiveness, and relevance by two fellowship trained consultant radiologists. RESULTS: The-literature.com produced 3 excellent summaries, 3 very poor summaries not relevant to the prompt, and one summary, which was relevant but did not include all relevant papers. All of the summaries produced by GPT-4 were relevant, but fewer relevant papers were identified. The average Likert rating was for the-literature was 2.88 and 3.86 for GPT-4. There was good agreement between the ratings of both radiologists (ICC = 0.883). CONCLUSION: Summaries produced by AI in its current state require careful human validation. GPT-4 on average provides higher quality summaries. Neither tool can reliably identify all relevant publications.
Asunto(s)
Inteligencia Artificial , Radiología , Humanos , Radiología/educación , Enfermedades Musculoesqueléticas/diagnóstico por imagen , Literatura de Revisión como AsuntoRESUMEN
The osseous pelvis is a well-known area of various primary and secondary bone tumours, tumour mimics, and infections. Isolated lesions of the pubis (ILP) are rare, with few case reports in the literature. Given their sparsity, such lesions may pose a great diagnostic challenge due to varied clinical presentations and imaging features. In this study, we report the largest case series of ILP. We discuss the patient demographics, differentials, surgical approaches, and management.
Asunto(s)
Neoplasias Óseas , Hueso Púbico , Humanos , Hueso Púbico/patología , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/patología , PelvisRESUMEN
INTRODUCTION: Grey Scale Inversion Imaging (GSII), a radiology reading software, has been utilized to improve anatomical and pathological delineation and consequently increase the diagnostic accuracy in a variety of trauma and Orthopaedic conditions. OBJECTIVE/AIM: The objective of this study was to assess whether Grey Scale Inversion Imaging (GSII) has any impact on the diagnostic accuracy and inter-observer reliability in diagnosing neck of femur fractures. METHOD: We performed a retrospective, single-centre study, to identify 50 consecutive anteroposterior (AP) pelvis radiographs of patients who presented to our unit with suspected neck of femur fractures between 2020 and 2021. The images included a combination of normal pelvic radiographs and others with features suggestive either intracapsular or extracapsular neck of femur fractures, which had been confirmed on computed tomography (CT), magnetic resonance imaging (MRI) and/or subsequent surgery. Four independent observers (two Trauma and Orthopaedics (T&O) consultants, one T&O Trainee Registrar (ST3 level) and one Trainee Senior House Officer (SHO in T&O) reviewed the images and graded each radiograph image using the Likert scale in response to the statement "there is a fracture". Following this, the same radiographs were inverted to Grey Scale Inversion Imaging (GSII) grey scale images and reassessed. RAND correlation was used for statistical analysis. RESULTS: Overall, observers appeared to have similar accuracy with normal radiographic imaging and with GSI sequences. CONCLUSION: Grey Scale Inversion Imaging (GSII) of digital radiographs did not affect the diagnostic accuracy of detecting neck of femur fractures in our study.
Asunto(s)
Fracturas del Fémur , Humanos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Fracturas del Fémur/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Fémur , Variaciones Dependientes del ObservadorRESUMEN
AIM: To assess gender-specific authorship trends in musculoskeletal (MSK) radiology in three major radiology journals, Skeletal Radiology (SR), Clinical Radiology (CR) and Indian Journal of Radiology and Imaging (IJRI). MATERIALS AND METHODS: Retrospective analysis of articles pertaining to MSK radiology was done for the years 2000, 2010, and 2020 for SR and CR and for the years 2010 and 2020 for IJRI. The number and positions of female authors was noted. RESULTS: Three hundred and twenty-five articles were reviewed after excluding the articles where the gender of one or more authors could not be conclusively determined. In SR, the percentage of female authors increased significantly from 4% in 2000 to 17% in 2010 (p<0.0001) and to 21.9% in 2020 (p<0.0001) with an increase in the percentage of first female authors from 0.8% in 2000 to 4.9% in 2010 and further to 5.4% in 2020. In CR, the percentage of female authors reduced from 13.8% in 2000 to 13.6% in 2010 (p=0.9798 and further reduced to 7% in 2020 (p=0.1592). In IJRI, the percentage of articles with no female authors went down from 36.4% (2010) to 26.7% (2020). CONCLUSION: There is an upward trend in female authorship in MSK radiology related articles in SR and IJRI with continued under-representation in CR. The first and middle order female authors have shown a significant increase, although the number of last female authors remains very low. Analysis of such trends in academic journals from other subspecialities in medicine needs to be undertaken to confirm or refute the findings of this study.
Asunto(s)
Autoria , Radiología , Bibliometría , Humanos , Estudios Retrospectivos , Factores SexualesRESUMEN
INTRODUCTION: Pes planus is a common three-dimensional (3D) deformity characterised by forefoot abduction, the collapse of the medial longitudinal arch, and hindfoot valgus. Several radiological measurements such as anteroposterior talocalcaneal angle (Kite's) and 'Calcaneal pitch angle' (CPA) exist to calculate the degree of hindfoot alignment in these patients with variable intra- and interobserver reliability. OBJECTIVE: To describe a new radiological ancillary method of measuring hindfoot alignment, the calcaneal offset index (COI). MATERIAL AND METHODS: Anteroposterior (mortise) and lateral view weight-bearing (WB) ankle radiographs of 200 consecutive patients referred for foot and ankle pain were reviewed. Demographic details, clinical indication, and COI calculation were undertaken on the mortise view along with the measurement of CPA for each patient. A one-way analysis of variance (ANOVA) was performed. Intraclass correlation coefficient (ICC) analysis was evaluated to assess the intraclass reliability between observers. RESULTS: There was a female preponderance of 2:1 in the study population with a mean age of 51.21 years (13-86 years). The calcaneal offset was increased in pes planus (hindfoot valgus). The p-value was 0.00023 on ANOVA. The COI gave an excellent interobserver correlation with ICC of 0.9 and moderate intraobserver reliability on the ICC analysis of 0.55. CONCLUSION: The COI can be an additional index of measuring hindfoot alignment in patients with pes planus. Contrary to the traditional angular measurements, this linear transverse plane measure is easier to calculate and reproducible. COI measurement has shown moderate intraobserver reliability but excellent interobserver reliability.
Asunto(s)
Calcáneo , Pie Plano , Calcáneo/diagnóstico por imagen , Femenino , Pie Plano/diagnóstico por imagen , Pie , Humanos , Persona de Mediana Edad , Radiografía , Reproducibilidad de los Resultados , Soporte de PesoRESUMEN
Meralgia Paresthetica (MP) causes outer thigh discomfort, numbness, and tingling. Compression or injury to the Lateral Femoral Cutaneous Nerve (LFCN), which gives sensory innervation to outer aspect of the thigh. It frequently gets impinged beneath the inguinal ligament resulting in in sensory impairment in the distribution of LFCN. Compression of the LFCN is a frequent cause of MP, whereas LFCN neuromas is a rare cause. This case report describes a unique case of Meralgia Paresthetica produced by a LFCN neuroma and enhances our knowledge of Meralgia Paresthetica.
RESUMEN
The introduction of the xxxxxxxx (GIBPS) technique represents a patient-centric novel and innovative method of ultrasound guided corticosteroid injection targeting the Glenohumeral joint (GHJ) and the Subacromial-Subdeltoid (SASD) bursa in a sequential manner, in the same setting. By integrating the two different sites of injection into a single technique, the procedure has the potential of transforming musculoskeletal interventional radiology and maximising patient care in shoulder pathologies. This procedure aims to reduce patient discomfort, optimise procedural efficiency, and enhance treatment precision through ultrasound guidance and improve the overall patient experience.
RESUMEN
PURPOSE: Haglund's deformity, an abnormality at the postero-superior corner of the calcaneus is a common cause of posterior heel pain. To date numerous measurements of radiological angles related to the calcaneus have been proposed to differentiate between symptomatic and asymptomatic patients with the deformity. Traditionally, these measurements have been assessed on plain radiographs. The aim of this study was to identify measurements which can be applied to Magnetic Resonance Imaging (MRI) studies of the ankle. METHODS: A retrospective cohort analysis of 30 MRI ankle studies from patients with symptomatic Haglund's deformity and 32 normal studies as controls was undertaken. The angle of BRINK, the Achilles angle, Calcaneal pitch, Achilles-plantar fascia angle and soleus calcaneal distance were measured on optimal T2 fat-saturated sagittal slices. RESULTS: There was a statistically significant difference (p < 0.0001) in the angle of BRINK between the Haglund's and control group. The Area-Under-the-Curve (AUC) was 0.7783 in keeping with good discrimination between the two groups. The angle of BRINK measurement is reproducible, with an intra-observer ICC of 0.837 and an inter-observer ICC of 0.824. There was no statistically significant difference between the two groups for the other measurements. In the Haglund's group the Achilles tendon was more likely to attach to the mid 1/3 of the posterior calcaneus as opposed to the superior 1/3 (p = 0.02), calcaneal oedema was more likely to be present (p < 0.001) and non-insertional tendinopathy was more likely to be present (p < 0.001). The presence of a retrocalcaneal bursa is non-specific (p = 0.602). CONCLUSION: The angle of BRINK demonstrates good discrimination between normal and Haglund's cases on MRI studies and may improve patient management by supporting surgical decision-making. Future work should correlate the angle of BRINK to long-term outcomes.
Asunto(s)
Calcáneo , Imagen por Resonancia Magnética , Humanos , Imagen por Resonancia Magnética/métodos , Estudios Retrospectivos , Calcáneo/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Reproducibilidad de los Resultados , Estudios de Casos y Controles , Radiografía , Deformidades del Pie/diagnóstico por imagenRESUMEN
BACKGROUND: Isolated tumours affecting the coccyx are infrequent, with only a handful of documented cases in the literature. Herein, we highlight the most extensive consecutive case series involving various isolated coccyx tumours with varied clinical presentations and imaging features. MATERIAL AND METHODS: A retrospective search of our tertiary Orthopaedic oncology institute's oncology and Radiology database (Radiology Information System (RIS), Picture Archiving and Communication System (PACS) and Computerised Radiology Information System (CRIS) for the keyword 'Coccyx' and 'Tumour' was performed over 15 years (between December 2007 to August 2022).Data collected was correlated with local histopathology and laboratory records. Patient demographics, clinical characteristics and complementary imaging findings were recorded for analysis. RESULTS: One hundred and three lesions originating in the coccyx with a mean age of 62 years (range 25 to 90 years) were identified. There was a male preponderance with 59 male and 44 female patients (1.3:1.0). The most typical tumour noted was chordoma. Other lesions included a dermoid cyst, a myxopapillary ependymoma, a notochordal remnant, an osteochondroma, an Ewings sarcoma and a teratoma. CONCLUSION: Our analysis suggests that most of the tumours involving coccyx are chordomas with a few rarely encountered benign and malignant tumors. Radiological imaging plays a vital role in characterising isolated tumours affecting the coccyx and guiding appropriate patient management. ADVANCES IN KNOWLEDGE: This is the largest reported series of coccygeal tumours. Chordoma is the commonest coccygeal tumour. Patients with unexplained coccydynia should undergo detailed investigations, preferably with cross-sectional imaging.
RESUMEN
We present a case of hand infection caused by Mycobacterium chelonae. The patient was a 58-year-old woman with Type II diabetes mellitus and stage 4 chronic kidney disease. The infection occurred following a ferret bite and had not responded to oral antibiotics in the primary care setting. She developed signs of pyogenic flexor tenosynovitis of the index and middle fingers of her left hand. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Ultrasound imaging confirmed the clinical diagnosis. Plain radiographs showed no osseous involvement. The infection was treated with surgical debridement and broad spectrum parenteral antibiotics. The intra-operative tissue specimens were initially negative on aerobic and anaerobic cultures. Following transient improvement of her inflammatory parameters and clinical signs, she developed a recurrence with added features of osteomyelitis of the index and middle finger metacarpal heads on repeat radiographs. A revision surgical debridement of the flexor tenosynovitis and osteomyelitis with specific long-term antibiotic cover has led to resolution of the infection. Extended cultures of the tissue specimens at the regional laboratory confirmed the causative organism to be M. chelonae. To our knowledge, this is the first reported case of M. chelonae infection resulting from a ferret bite. This case reminds us of the need for a high index of suspicion for infection with uncommon pathogens following animal bites, especially in patients with altered immune status.
Asunto(s)
Mordeduras y Picaduras/complicaciones , Hurones , Traumatismos de la Mano/etiología , Traumatismos de la Mano/microbiología , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Mycobacterium chelonae , Animales , Femenino , Traumatismos de la Mano/diagnóstico , Traumatismos de la Mano/terapia , Humanos , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/terapia , Resultado del TratamientoRESUMEN
The popularity of weight training, bodybuilding and general physical conditioning has led to an increased rate of musculoskeletal injuries, such as nerve compression caused by muscle hypertrophy and, stretching of nerves peripherally. We present a case of anterior interosseous nerve (AIN) entrapment syndrome/neuropathy otherwise known as Kiloh-Nevin syndrome in a 22-year-old weightlifter. Knowledge of this injury is paramount for practitioners to increase awareness among athletes and bodybuilders.
RESUMEN
Radiology plays a crucial part in the diagnosis and management of patients. Several techniques have been used to decrease the diagnostic error rate. We discuss the concept, use and advantages of grayscale inversion imaging in orthopedics.
RESUMEN
Introduction: Primary synovial osteochondromatosis (SOCM) or Synovial chondromatosis (SC) of the hip is a benign metaplastic condition of the synovium that is rare and may present with a spectrum of clinical features and radiological findings. Patients and methods: A retrospective search using the keyword 'Synovial chondromatosis' (SC) of the hip was performed at a tertiary care orthopaedic referral centre in the UK and a hospital in India. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS), over 15 years. The patient's data was collated with Electronic Patient Records (EPR), RIS, and correlated with histo-pathology laboratory records where available. The demographic details of the patients, their clinical symptoms, imaging details, and management outcomes were collected. Results: We found 15 cases, with a mean age of 36.53 years (range: 14-50 years). There were 9 male and 6 female patients. The follow-up ranged from 1 year to 6 years. Predominantly unilateral presentation with insidious onset of symptoms was found. A spectrum of radiological Imaging was undertaken. Management strategies included supervised observation, arthroscopic or open synovectomy, and hip arthroplasty. No malignant transformation was found in the analysed cohort. Conclusion: Primary 'Synovial chondromatosis' of the hip had a male preponderance in our cohort, presenting with a range of clinical features. Radiologically, Magnetic Resonance Imaging (MRI) was the commonest modality of cross-sectional imaging utilised and crucial for the diagnosis, evaluating underlying articular involvement including guiding appropriate patient management presenting with Primary 'Synovial chondromatosis' of the hip.
RESUMEN
INTRODUCTION: Trochlear Dysplasia (TD) is a condition that is characterized by the presence of an abnormally shaped trochlear groove, which hinders the patellofemoral joint (PFJ) stability. PFJ stability is determined by static and dynamic structures around the knee joint. We analysed whether the patellar tendon morphology is altered in patients with patellofemoral instability in Trochlear Dysplasia (TD). MATERIAL AND METHODS: Magnetic Resonance Imaging (MRI) studies for 50 consecutive knees with TD and 50 consecutive knees with normal PFJ morphology were obtained for evaluation. For each MRI study, the cross-sectional area (CSA) of the medial and lateral components of the patellar tendon was measured and used to calculate the cross-sectional area ratio (CSAR) by two readers. RESULTS: There was a statistically significant difference in the CSAR of the lateral-to-medial components of the patellar tendon between knees with normal PFJ morphology and knees with TD (one way ANOVA, F (4,95) = 7.743, p < 0.001). Pairwise comparisons amongst the Dejour subtypes of TD, revealed a statistically significance difference (p < 0.05) in the CSAR ratio between patients with normal PFJ morphology, and patients with type A (p = 0.007) and type C, TD. There was moderate correlation between the readers on Intraclass Correlation Coefficient (ICC) analysis (ICC- 0.7). CONCLUSION: Our findings reveals hypertrophy of the medial part of the patellar tendon in patients with PFJ instability and TD. These differences could reflect the dynamic compensatory changes occurring at the PFJ to counteract the laterally directed instability vectors found in this condition.
RESUMEN
BACKGROUND: Isolated fractures of the greater trochanter are unusual injuries with a wide spectrum of presentation, investigations and management strategies. AIMS: The objective of this study was to evaluate the incidence and treatment protocols used in the management of Isolated Greater Trochanteric Fractures (IGTF). METHODS: A systematic literature review of the PubMed and Central Register of Controlled Trials (Cochrane) databases by using the search term 'greater trochanter fracture and hip fracture' was conducted for Randomised Controlled Trials (RCT's), including prospective and retrospective non-experimental studies. RESULTS: The search yielded 15 studies meeting our inclusion criteria encompassing 166 patients with Isolated Greater Trochanteric Fractures (IGTF). Most of the reports were observational studies due to paucity of coverage on this topic in literature. Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) were the common modalities used to diagnose these injuries. Most of the patients were managed with non-operative methods. CONCLUSION: This systematic review analyses the consensus of treatment of IGTF based on evidence-based practice. When the IGTF is identified, the majority of studies advocate conservative management to surgery for such cases. Furthermore, large cohort studies with clearly documented outcome follow up are required to establish objective treatment guidelines for IGTF.
RESUMEN
The Iyengar-Botchu confluence is a quadrilateral space on the medial side of the knee. Due to the presence of unique anatomical structures, this region is prone to injuries. The aim of this pictorial review is to illustrate an anatomical description of the structures, which form the IB complex confluence. Clinico-pathological correlation of common conditions associated with these structures will increase awareness of injuries in this area. A complementary imaging guidance will support clinical diagnosis and appropriate patient management.
RESUMEN
INTRODUCTION: The social lockdown measures imposed to contain the COVID-19 pandemic, have had profound effects on the healthcare systems across the world and India has been no exception to it. The study was aimed to evaluate the impact of COVID-19 on orthopaedic practice in India during the lockdown period and assess the preparedness of orthopaedic surgeons for resuming clinical practice after the initial lockdown was lifted. MATERIALS AND METHODS: An online survey of 35 questions was conducted to evaluate impact on (i) general orthopaedic practice (ii) hospital protocols (iii) out-patient practice (iv) surgical practice (v) personal protective equipment (PPE) use and (vi) post-lockdown preparedness. RESULTS: A total number of 588 practising orthopaedic surgeons from India completed the survey. Majority (88.3%) found severe impact (>50%) on trauma surgery and non-trauma surgery with significant reduction in out -patient attendance compared to corresponding time in 2019. There were significant changes made in individual hospital protocols (91.7 %). Appropriate required PPE was available in majority of the hospitals (74.3%). No remodelling or upgrading of the existing operating theatre infrastructure was done by most surgeons (89.5%). CONCLUSION: This pan India survey of orthopaedic surgeons has indicated that COVID-19 has had a profound impact on their outpatient and surgical trauma and non-trauma practice, due to the lockdown and resulted in significant changes to hospital protocols. Preparedness to resume clinical and surgical practice was associated with anxiety in two-thirds of the respondents. Majority of the orthopaedic practitioners felt that they would continue to conduct pre-operative COVID-19 screening and use PPE even after the lockdown is over.
RESUMEN
INTRODUCTION: Infection of a total knee replacement (TKR) is a very serious complication of knee arthroplasty surgery as the repercussions for the patient often include long-term antibiotics, further surgery, revision surgery, and worse outcomes in the long-term including increased morbidity and mortality. As such, the careful assessment of a patient presenting with an acutely inflamed TKR is of paramount importance. CASE REPORT: We report a case of a patient presenting with the clinical signs and symptoms of an acute infection of their TKR. The patient was ultimately diagnosed as having pseudogout. CONCLUSION: This case illustrates that crystal arthropathy must be one of the differential diagnoses for a suspected infection of a TKR, as failure to recognize this may result in unnecessary and detrimental treatment.