Is There Any Difference Between a Spherical Marker and a Simple Coin for Hip Replacement Digital Planning? / Existe alguma diferença entre um marcador esférico e uma moeda simples para planejamento digital de substituição de quadril?

Abstract Objective To evaluate the accuracy and differences between 2 types of metallic markers, sphere, and coin, for radiographic calibration in the preoperative planning of hip arthroplasty. Methods Four spherical metallic markers and four coins, both 25 mm in diameter, were placed on the greater trochanter, pubic symphysis, between the thighs, and on the table of the exam, for radiographic examination of the hip in 33 patients with hip prosthesis. The prosthesis head was used for calibration and two examiners measured the markers' image diameters, and the results were analyzed statistically. Results In the greater trochanter, the sphere and the coin were not visualized in 19 radiographs (57.6%). Between the thighs, the coin marker was not visualized in 13 radiographs (39.4%). In the greater trochanter, the 25-mm accuracy of the coin and the sphere was, respectively, between 57.1 and 63.3% and between 64.3 and 92.9%. The coin between the thighs reached 25-mm accuracy in between 50 and 60% of cases. Over the exam table, the coin and sphere markers reached, respectively, the mean diameters of 22.91 mm and 23 mm, the lowest coefficient of variation, the lowest confidence interval, and the easiest positioning. There was statistical difference between the evaluations of the markers (coin vs. sphere) in all positions (p< 0.032), except for the exam table position (p= 0.083). Conclusions The coin between the thighs is the best marker for radiographic calibration in the preoperative planning of hip arthroplasty, and we suggest the use of another coin on the exam table for comparison, considering the 8% reduction in relation to its real size.

Resumo Objetivo Avaliar a precisão e as diferenças entre 2 tipos de marcadores metálicos, esfera e moeda, para calibração radiográfica no planejamento pré-operatório da artroplastia de quadril. Métodos Quatro marcadores metálicos esféricos e quatro moedas, ambas de 25 mm de diâmetro, foram colocadas em trocânter maior, sínfise púbica, entre as coxas e a mesa do exame, para exame radiográfico do quadril em 33 pacientes com prótese de quadril. A cabeça da prótese foi utilizada para calibração e dois examinadores mediram os diâmetros da imagem dos marcadores, e os resultados foram analisados estatisticamente. Resultados No trocânter maior, a esfera e a moeda não foram visualizadas em 19 radiografias (57,6%). Entre as coxas, o marcador de moeda não foi visualizado em 13 radiografias (39,4%). No trocânter maior, a precisão de 25 mm da moeda e da esfera foi, respectivamente, entre 57,1 e 63,3% e entre 64,3 e 92,9%. A moeda entre as coxas atingiu 25 mm de precisão entre 50 e 60%. Sobre a mesa de exame, os marcadores de moeda e esfera atingiram, respectivamente, diâmetros médios de 22,91 mm e 23 mm, o menor coeficiente de variação, o menor intervalo de confiança e o posicionamento mais fácil. Houve diferença estatística entre as avaliações dos marcadores (moeda vs. esfera) em todas as posições (p< 0,032), com exceção da posição na mesa de exame (p= 0,083). Conclusões A moeda entre as coxas é o melhor marcador para calibração radiográfica no planejamento pré-operatório da artroplastia de quadril, e sugerimos o uso de outra moeda na mesa de exame para comparação, considerando os 8% de redução em relação ao seu tamanho real.

Importance of the use of pre- and intra-operative imaging as a tool for planning foreign body removal in the floor of the mouth: a case report / Importancia del uso de la imagenología pre e intraoperatoria como herramienta para la planificación de remoción de cuerpo extraño en piso de boca: presentación de un caso

Introduction: Body piercings consist of small holes made with a needle in different parts of the skin or body to introduce a jewel or decorative element. In the oral cavity, most piercings are placed in the tongue. However, some complications may occur, and surgical techniques must be used for their removal. These complications present a certain degree of difficulty due to their position and may challenge the ability of the clinician to access the specific anatomical location. The different imaging techniques, from simple radiography to intraoperative techniques such as image intensifiers, have become an extremely useful tool for locating an object in the three dimensions of space, allowing safe location and extraction. Objective: The aim of this study is to report the case of a complication of a body piercing in the oral cavity and how the use of imaging was decisive for surgical planning and for the quick and effective resolution of the case. Material and Methods: A 14-year-old female patient came looking for treatment. Her mother reported the onset of the condition after the insertion of a needle-like metallic object while performing an artistic perforation in the lingual region. Since the girl was unable to extract the object, she sought medical advice at the Carlos Arvelo Military Hospital in Caracas, Venezuela. Subsequently, an imaging study was performed by means of a Computed Tomography to locate the metallic object. It was observed that the foreign body had migrated to the floor of the mouth/sublingual region, requiring the area to be surgically approached. It was also decided to use an intraoperative image intensifier. The removal of the object was performed satisfactorily. Conclusion: The extraction of foreign bodies placed in the lingual and sublingual region represents a challenge for the clinician due to the number of important anatomical structures that pass through that area. This makes clinicians plan their surgical removal using pre- and intraoperative imaging, to find a less traumatic location, reduce surgical time as well as the risk of damaging adjacent anatomical structures.

Introducción: Los body piercings consisten en producir perforaciones con una aguja en diferentes localizaciones de la piel con el fin de introducir una joya o elemento decorativo a través del agujero producido previamente. En la cavidad oral, la lengua es el sitio de mayor elección; sin embargo, en ciertas ocasiones suelen presentarse ciertas complicaciones, por lo cual se debe recurrir a técnicas quirúrgicas para su remoción presentando cierto grado de dificultad para su localización y la capacidad del clínico para acceder al espacio anatómico. Las diferentes técnicas imagenológicas desde una radiografía simple hasta técnicas intraoperatorias como los intensificadores de imágenes se han convertido en una herramienta sumamente útil para la ubicación de un objeto en las tres dimensiones del espacio, permitiendo una localización y extracción segura para el clínico y el paciente. Objetivo: El propósito de este trabajo es reportar un caso de una complicación de esta práctica en la región bucal y cómo el uso de la imagenología fue determinante para la planificación quirúrgica y la resolución del caso de manera rápida y efectiva. Material y Métodos: Se presenta a consulta una paciente femenina de 14 años de edad, quien madre refiere inicio de enfermedad actual posterior a introducirse objeto metálico tipo aguja de compás con la finalidad de realizar perforación artística en región lingual, al no poder extraer dicho objeto, acude a evaluación en el Hospital Militar Carlos arvelo de Caracas; posterior se realiza estudio imagenológico tipo Tomografía Computarizada para la ubicación del objeto metálico donde se observa que el cuerpo extraño habría migrado hacia el piso de boca/región sublingual, teniendo la necesidad de abordar quirúrgicamente la zona y elegir el uso de intensificador de imagen transoperatorio para retiro del mismo el cual se dio de manera satisfactoria. Conclusión: Los cuerpos extraños desplazados a la región lingual y sublingual representan un desafío para el clínico al momento de extraerlos, esto se debe a la cantidad de estructuras anatómicas importantes que pasan por dicha zona, lo que hace que el clínico opte en su planificación quirúrgica por el uso de imagenología pre y transoperatoria obteniendo así una localización menos traumática, menor tiempo operatorio y menor riesgo de lesión de estructuras anatómicas adyacentes.

Is it Important to Know Where to Place the Spherical Marker for Hip Replacement Digital Planning? / É importante saber onde posicionar o marcador esférico para o planejamento digital de artroplastia de quadril?

Abstract Objective The present paper aims to evaluate the influences of individual characteristics in radiographic magnification and to identify the most accurate method for radiographic calibration. Methods During radiographical exam of 50 patients with hip prosthesis, anthropometric data was collected and 4 spherical metal markers with 25 mm diameters were positioned: at the greater trochanter level and lateral to it, over the pubic symphysis, between the thighs at the greater trochanter level, and over the exam table. Since the prosthesis head is the best internal radiographic marker for hip arthroplasty, it was our calibration parameter. Two examiners measured the markers' image for further analysis. Results The sample consisted of 50 participants, 19 of whom were male. A difference in pubic symphysis magnification was found. Other individual characteristics (weight, height and body mass index) had weak correlation. The higher accuracy of the markers was at the greater trochanter, between 68.4 and 78.9%, visualized in only19 radiographs. The marker positioned between the thighs was visualized in all radiographs, with an accuracy ranging from 30 to 46%. Conclusions Of all individual characteristics, only gender influences magnification at the pubic symphysis. We suggest the use of two spherical markers: at the greater trochanter, due the best accuracy, and between the thighs, considered the best positioning for better visibility.

Resumo Objetivo Os objetivos desse artigo são avaliar as influências das características pessoais na magnificação radiográfica e identificar o método de maior acurácia e o mais adequado. Métodos Durante o exame radiográfico em 50 pacientes com prótese de quadril, foram coletados dados antropométricos e posicionados quatro marcadores metálicos esféricos: ao nível e lateral ao trocânter maior, na sínfise púbica, ao nível do trocânter maior entre as coxas, sobre a mesa do exame. A cabeça da prótese é o melhor marcador radiográfico interno e foi o nosso parâmetro de calibragem. Dois avaliadores mediram as imagens desses marcadores para análise de resultados. Resultados Foram selecionados 50 participantes, sendo 19 do sexo masculino. Houve diferença de magnificação entre os sexos na posição sínfise púbica. As outras características pessoais avaliadas (peso, altura e índice de massa corpórea) tiveram correlação fraca. A maior acurácia do marcador foi no trocânter maior, entre 68,4 e 78,9%, visualizado em apenas 19 radiografias. O marcador entre as coxas obteve acurácia entre 30 e 46% e foi visualizado em todas as radiografias. Conclusão Das características pessoais, apenas o sexo influencia a magnificação e somente na posição da sínfise púbica. Sugerimos padronizar o uso de duas esferas: no trocanter maior, pela maior acurácia, e entre as coxas, por ser o mais adequado e com melhor visibilidade em todas radiografias.

Cuantificación de la distorsión presente en la radiografía posteroanterior de cráneo / Quantification of the distortion present in the postero-anterior cephalogram

RESUMEN Introducción: Universalmente se acepta que la radiografía postero-anterior de cráneo presenta menor grado de distorsión que otras imágenes radiográficas, por lo que las mediciones en ella son consideradas confiables. Objetivo: Determinar el porcentaje de distorsión que se presenta en las diferentes regiones faciales de la radiografía posteroanterior de cráneo. Métodos: Treinta cráneos humanos con sus mandíbulas fueron divididos por tres planos horizontales y cuatro verticales en quince cuadrantes; resultaron diez en el cráneo y cinco en la mandíbula. En cada uno de ellos se colocó un alambre de acero en posiciones vertical y horizontal y se midió su longitud (medida real). A cada conjunto se le tomó una radiografía en proyección postero-anterior y se midió la longitud de los alambres en la imagen (medida radiográfica). Resultados: No fue posible medir en los cuadrantes laterales del cráneo. La medida horizontal en los cuadrantes intermedios inferiores derecho e izquierdo del cráneo y en los cuadrantes intermedio y lateral de ambos lados de la mandíbula no es confiable; en el cuadrante mediano de la mandíbula se minimiza; en los cuadrantes medianos superior e inferior e intermedios superiores derecho e izquierdo del cráneo se magnifica. Las medidas verticales en todos los cuadrantes son confiables; en los cuadrantes intermedios superiores derecho e izquierdo del cráneo y en los intermedios y laterales derechos e izquierdos de la mandíbula se magnifica; en los cuadrantes intermedios inferiores y medianos superior e inferior del cráneo y mediano de la mandíbula se minimiza. La menor distorsión para ambas medidas se presenta en el cuadrante mediano superior del cráneo. Se reportan los porcentajes de distorsión para cada cuadrante. Conclusiones: Se presenta distorsión en la radiografía postero-anterior de cráneo y esta varía de una región a otra de la cara(AU)

ABSTRACT Introduction: Universally, it has been accepted that the postero-anterior cephalogram presents less distortion than any other x-ray radiograph; for this reason, the measurements taken on it are considered reliable. Objective: To determine for a postero-anterior cephalogram, what percentage of distortion is present in different regions of the skull and mandible. Methods: Thirty human skulls with their mandibles were divided by three horizontal and four vertical planes in fifteen quadrants, resulting ten in the skull and five in the mandible. In each quadrant, one vertical and one horizontal steel wire were fixed and their lengths were measured (real value). To each set, a postero-anterior cephalogram was taken and the wire images were measured (radiograph value). Results: No measurement could be taken in the lateral quadrants of the skull. The horizontal measurement in the right and left intermediate inferior quadrants of the skull and in the right and left intermediate and lateral quadrants of the mandible is not reliable; in the median quadrant of the mandible it is minimized; in the median superior and inferior and intermediate superior right and left quadrants of the skull it is magnified. The vertical measurement in all the quadrants is reliable; in the right and left intermediate superior quadrants of the skull and right and left intermediate and lateral quadrants of the mandible it is magnified; in the right and left intermediate inferior and median superior and inferior quadrants of the skull and median quadrant of the mandible it is minimized. The minimum distortion for both measurements is present in the median superior quadrant of the skull. The percentage of distortion in each quadrant for both measurements is reported. Conclusions: Distortion is present in the postero-anterior cephalogram and it varies from one region to another of the face(AU)

Comparison of Vertical Magnification Ratio among Various Areas in Panoramic Radiographs

PURPOSE: The objective of the present article is to determine whether there are differences in vertical enlargement ratio among various sites within both jaws in a panoramic radiograph. MATERIALS AND METHODS: Two hundred and seventy-threeimplant sites in panoramic radiographs were evaluated by two observers. Magnification ratios at various sites in both jaws were calculated and compared with each other. RESULT: The average vertical enlargement ratio in the panoramic radiograph was 1.264 and this value was larger than original ratio 1.250. Although vertical magnification ratio of maxillary molar area was higher than that of mandibular molar area, every group showed similar magnification ratio in clinical respect. CONCLUSION: Vertical magnification ratio of the maxillary molar area is statistically higher than that of the mandibular molar area in the panoramic radiograph, but it is clinically negligible.

Factors Related to Radiation Exposure during Lumbar Spine Intervention

Fluoroscopy guidance is useful to confirm anatomical landmark and needle location for spine intervention; however, it can lead to radiation exposure in patients, physicians, and medical staff. Physicians who used fluoroscopy should be cognizant of radiation exposure and intend to minimize radiation dose. We retrospectively reviewed three lumbar spine intervention procedures (nerve root block, medial branch block, and facet joint block) at our institution between June and December, 2014. We performed 268 procedures on 220 patients and found significant difference in radiation dose between two groups classified by performing physicians. The physician who controlled the fluoroscopy unit directly used significantly shorter fluoroscopy (6 seconds) that resulted in a smaller radiation dose (dose area product [DAP] 0.59 Gy.cm2) than the physician supervising the radiographer controlling the fluoroscopy unit (72 seconds, DAP 5.31 Gy.cm2, P < 0.001). The analysis indicates that the difference in fluoroscopy time depends on whether a physician or a radiographer controls the fluoroscopy unit.

Evaluation of radiographic magnification in lateral cephalograms obtained with different X-ray devices: experimental study in human dry skull

OBJECTIVE: The purpose of this study was to evaluate the influence of the magnification factor of the radiographic image in angular, linear and proportional measurements. METHODS: From a dried human skull where metallic spheres with predetermined size were fixed (1.0 mm), 14 radiographs were obtained in devices of three different manufacturers: Panoura, Instrumentarium and Tomeceph. The Pearson correlation test was used to investigate the relationship between the rate of radiographic magnification and the cephalometric measurements assessed. RESULTS: According to the results, the linear measurements showed a high positive correlation, pointing out great influence of the magnification factor, while the angular and proportional measurements did not correlate. CONCLUSIONS: Comparisons between linear cephalometric measurements obtained with different devices from the same manufacturer showed maximum rates of expansion of 0.6%, 1.25% and 2.3%, respectively, for the devices from Instrumentarium (OP-100, Instrumentarium, Finland), Panoura (10CSU, Yoshida, Japan) and Satelec/Tomeceph (XMind, Satelec/Tomeceph Orion Corporation, Finland).

OBJETIVO: avaliar a influência do fator de magnificação da imagem radiográfica nas grandezas angulares, lineares e proporcionais. MÉTODOS: a partir de um crânio seco humano, no qual foram fixadas esferas metálicas de dimensões pré-definidas (1,0mm de diâmetro), 14 telerradiografias foram obtidas em diferentes aparelhos de três fabricantes: Panoura, Instrumentarium e Tomeceph. Foi realizada a análise estatística descritiva e utilizado o teste de correlação de Pearson para verificar a relação entre a taxa de magnificação radiográfica e as grandezas cefalométricas analisadas. RESULTADOS: as medidas lineares apresentaram alta correlação positiva, evidenciando grande influência do fator de magnificação sobre essas grandezas, ao passo que as angulares e proporcionais não apresentaram correlação. CONCLUSÃO: comparações entre medidas cefalométricas lineares obtidas com diferentes aparelhos do mesmo fabricante demonstraram taxas de ampliações máximas de 0,6%, 1,25% e 2,3%, respectivamente, para os aparelhos Instrumentium (OP-100 Instrumentarium), Panoura (10CSU Yoshida) e Satelec/Tomeceph (XMind Satelec/Tomeceph Orion Corp).

Comparison between electronic and radiographic method for the determination of root canal length in primary teeth

Introduction: There are few researches in literature that mention the use of the apex locator in deciduous teeth and working length is obtained through radiographies. Objective: The purpose of this research was to compare the radiographic and the electronic method to obtain the working length in deciduous molars. Material and methods: Twelve molar teeth were used. The specimens in the visual method had their root length measured through the passive insertion of a 10 K-file with a silicone stop within root canal until its tip was seen at the apical foramen. The working length was measured through radiographs or using the apex locator Root ZX II. The mean between the examiners was submitted to the variance analysis (ANOVA). Results: Statistically significant differences were found between the visual method and the radiographic method (p < 0.001). There was no significant difference between the working length measurements in visual method and those obtained with the apex locator (p = 0.1319). Conclusion: The apex locator is indicated as a clinical implementation for endodontic treatment in primary teeth.

Evaluation of the panoramic image formation in different anatomic positions

The aim of this study was to determine size, shape and position of the image layer by evaluation of the radiographic image formation in different anatomic positions. A customized phantom was made of a rectangular acrylic plate measuring 14 cm² and 0.3 cm thick, with holes spaced 0.5 cm away and arranged in rows and columns. Each column was separately filled with 0.315 cm diameter metal spheres to acquire panoramic radiographs using the Orthopantomograph OP 100 unit. The customized phantom was placed on the mental support of the device, with its top surface kept parallel to the horizontal plane, and was radiographed at three different heights from the horizontal plane, i.e., the orbital, occlusal and mandibular symphysis levels. The images of the spheres were measured using a digital caliper to locate the image layer. The recorded data were analyzed statistically by the Student'-t test, ANOVA and Tukey' test (?=0.05). When the image size of spheres in horizontal and vertical axes were compared, statistically significant differences (p<0.05) were observed in all areas, portions of the image layer and heights of horizontal plane evaluated. In the middle portion of the image layer, differences in the image size of spheres were observed only along the horizontal axis (p<0.05), whereas no differences were observed along the vertical axis (p>0.05). The methodology used in this determined the precise size, shape and position of the image layer and differences in magnification were observed in both the horizontal and vertical axes.

O objetivo na presente pesquisa foi determinar o tamanho, forma e posição da camada de imagem por meio da avaliação da formação da imagem radiográfica em diferentes posições anatômicas. Foi construído um phantom constituído por uma placa acrílica de 14 cm² e 0,3 cm de espessura, com sua superfície contendo perfurações a cada 0,5 cm dispostas em linhas e colunas. O phantom foi posicionado no local do apoio de mento do aparelho panorâmico, com sua superfície paralela ao plano horizontal. Esferas metálicas de 0,315 cm foram inseridas nas perfurações, e executadas radiografias panorâmicas. Cada coluna de cada quadrante foi individualmente preenchida pelas esferas para a execução das radiografias, em três planos horizontais diferentes: alturas orbital, oclusal e mentual. As imagens das esferas foram medidas com o uso de um paquímetro digital e a camada de imagem localizada. Os dados foram analisados estatisticamente utilizando-se o teste T Student, ANOVA e teste de Tukey (?=0,05). Quando o tamanho das esferas nos eixos horizontal e vertical foi comparado, diferenças estatisticamente significativas (p<0,05) foram observadas em todas as áreas da camada de imagem, porções e alturas do plano horizontal avaliado. Na porção central da camada de imagem diferenças no tamanho das esferas foram observadas somente no eixo horizontal (p<0,05), enquanto que no eixo vertical nenhuma diferença foi observada (p>0,05). A metodologia utilizada determinou com precisão o tamanho, forma e posição da camada de imagem, e diferenças de ampliação foram observadas tanto no eixo horizontal quanto vertical.

Estudo comparativo de radiografias cefalométricas executadas com diferentes distâncias filme-objeto no tocante à interpretação de grandezas cefalométricas / Comparative study of cephalometric radiographs obtained with different film-object distances concerning cephalometric analysis interpretation

Introdução - Durante a execução de uma radiografia deve-se seguir preceitos que visam diminuir as distorções e ampliações inerentes à técnica, como distâncias focal, filme-objeto e posicionamento do paciente. O objetivo deste estudo foi verificar se alterações na distância filme-objeto alteram significativamente a cefalometria. Material e Métodos - Foram executadas duas radiografias cefalométricas de esferas metálicas no aparelho Planmeca Proline XC, sendo uma com distância filme-objeto de 7 cm e outra com distância de 14 cm. Os traçados cefalométricos computadorizados foram realizados e seus valores comparados. Resultados - Os valores obtidos em cada análise cefalométrica não mostraram diferenças significantes e não alteraram a interpretação das grandezas cefalométricas utilizadas neste estudo. Conclusão - No aparelho utilizado, o aumento da distância filme-objeto de 7 para 14 cm não interfere na análise cefalométrica.

Introduction - During the execution of a radiography, precepts that seek to reduce the distortions and inherent enlargements of the technique should be proceeded, as focal distances, film-object and the patient's positioning. The aim of this study was to verify if alterations in the film-object distance alter significantly cephalometric data. Material and Methods - Two cephalometic radiographs of metallic spheres were executed in the Planmeca Proline XC machine, being one with 7 cm film-object distance and other with distance of 14 cm. The computerized cefalometric data were accomplished and their values compared. Results - The obtained values in each analysis didn't show significant differences and they didn't alter the interpretation of the cephalometric pattern used in this study. Conclusion - In the used apparatus, the increase of the film-object distance from 7 to 14 cm doesn't interfere in the cephalometric analysis.