Progress on artificial intelligence assisted X-ray film recognition in orthopedics / 中国骨伤

As an important tool for assessing musculoskeletal conditions, imaging plays an important role in assessing the risk of disease, judging disease and the progress of disease, and prognosis scores. Accompanied with the rapid development of artificial intelligence(AI) in the field of image detection and interpretation, some AI-assisted recognition studies involving musculoskeletal X-ray imaging have been examined and shown a high potential value, which can enhance various parts of the X-ray imaging value chain and guide clinicians by improving imaging efficiency, imaging quality, and diagnostic accuracy. At present, the development of AI-assisted imaging recognition technology is still at an early stage. AI algorithms need to be further improved and developed. Image data is still insufficient and the qualityis relatively heterogeneous. The long-term accuracy and stability of technical performance require further observation and research.

Radiopacity of endodontic materials using two models for conversion to millimeters of aluminum

Abstract The aims of the present study were to compare conventional radiography, radiographs digitized with a scanner or photographic camera, and digital radiography, used to evaluate the radiopacity of endodontic materials, and to compare the accuracy of linear and quadratic models used to convert radiopacity values to equivalent millimeters of aluminum (mm Al). Specimens of AH Plus, Endofill, Biodentine and BioMTA materials (n = 8) were radiographed next to an aluminum step-wedge using radiographic films and digital radiography systems (FONA CMOS sensor, Kodak CMOS sensor and photosensitive phosphor plate-PSP). Conventional radiographs were digitized using a scanner or photographic digital camera. Digital images of all the radiographic systems were evaluated using dedicated software. Optical density units (ODU) of the specimens and the aluminum step-wedge were evaluated by a photo-densitometer (PTDM), used in conventional radiographs. The radiopacity in equivalent mm Al of the materials was determined by linear and quadratic models, and the coefficients of determination (R2) values were calculated for each model. Radiopacity of the materials ranged from -9% to 25% for digital systems and digitized radiographs, compared to the PTDM (p < 0.05). The R2 values of the quadratic model were higher than those of the linear model. In conclusion, the FONA CMOS sensor showed the lowest radiopacity variability of the methodologies used, compared with the PTDM, except for the BioMTA group (higher than PTDM). The quadratic model showed higher R2 values than the linear model, thus indicating better accuracy and possible adoption to evaluate the radiopacity of endodontic materials.

Multilevel Percutaneous Vertebroplasty (More than Three Levels) in the Management of Osteoporotic Fractures

OBJECTIVE: Percutaneous vertebroplasty (PV) is a minimally invasive procedure designed to treat various spinal pathologies. The maximum number of levels to be injected at one setting is still debatable. This study was done to evaluate the usefulness and safety of multilevel PV (more than three vertebrae) in management of osteoporotic fractures.METHODS: This prospective study was carried out on consecutive 40 patients with osteoporotic fractures who had been operated for multilevel PV (more than three levels). There were 28 females and 12 males and their ages ranged from 60 to 85 years with mean age of 72.5 years. We had injected 194 vertebrae in those 40 patients (four levels in 16 patients, five levels in 14 patients, and six levels in 10 patients). Visual analogue scale (VAS) was used for pain intensity measurement and plain X-ray films and computed tomography scan were used for radiological assessment. The mean follow-up period was 21.7 months (range, 12–40).RESULTS: Asymptomatic bone cement leakage has occurred in 12 patients (30%) in the present study. Symptomatic pulmonary embolism was observed in one patient. Significant improvement of pain was recorded immediate postoperative in 36 patients (90%).CONCLUSION: Multilevel PV for the treatment of osteoporotic fractures is a safe and successful procedure that can significantly reduce pain and improve patient’s condition without a significant morbidity. It is considered a cost effective procedure allowing a rapid restoration of patient mobility.

Multilevel Percutaneous Vertebroplasty (More than Three Levels) in the Management of Osteoporotic Fractures

OBJECTIVE: Percutaneous vertebroplasty (PV) is a minimally invasive procedure designed to treat various spinal pathologies. The maximum number of levels to be injected at one setting is still debatable. This study was done to evaluate the usefulness and safety of multilevel PV (more than three vertebrae) in management of osteoporotic fractures. METHODS: This prospective study was carried out on consecutive 40 patients with osteoporotic fractures who had been operated for multilevel PV (more than three levels). There were 28 females and 12 males and their ages ranged from 60 to 85 years with mean age of 72.5 years. We had injected 194 vertebrae in those 40 patients (four levels in 16 patients, five levels in 14 patients, and six levels in 10 patients). Visual analogue scale (VAS) was used for pain intensity measurement and plain X-ray films and computed tomography scan were used for radiological assessment. The mean follow-up period was 21.7 months (range, 12–40). RESULTS: Asymptomatic bone cement leakage has occurred in 12 patients (30%) in the present study. Symptomatic pulmonary embolism was observed in one patient. Significant improvement of pain was recorded immediate postoperative in 36 patients (90%). CONCLUSION: Multilevel PV for the treatment of osteoporotic fractures is a safe and successful procedure that can significantly reduce pain and improve patient’s condition without a significant morbidity. It is considered a cost effective procedure allowing a rapid restoration of patient mobility.

A Case of Unknown Cause of Subcutaneous Emphysema Presented by Generalized Edema

Subcutaneous emphysema and pneumomediastinum are commonly derived from trauma or injury of respiratory or gastrointestinal tracts, but occasionally the origin of air was not determined at evaluation. We report on a case of severe subcutaneous emphysema detected using simple X-ray films in the emergency department, which extended to almost all of the bodies, with a review of the literature.

Measurement of Clavicle Fracture Shortening Using Computed Tomography and Chest Radiography

BACKGROUND: Nonoperative management of midshaft clavicle fractures has resulted in widely disparate outcomes and there is growing evidence that clavicle shortening poses the risk of unsatisfactory functional outcomes due to shoulder weakness and nonunion. Unfortunately, the literature does not clearly demonstrate the superiority of one particular method for measuring clavicle shortening. The purpose of this study was to compare the accuracy of clavicle shortening measurements based on plain radiographs with those based on computed tomography (CT) reconstructed images of the clavicle. METHODS: A total of 51 patients with midshaft clavicle fractures who underwent both a chest CT scan and standardized anteroposterior chest radiography on the day of admission were included in this study. Both an orthopedic surgeon and a musculoskeletal radiologist measured clavicle shortening for all included patients. We then determined the accuracy and intraclass correlation coefficients for the imaging modalities. Bland-Altman plots were created to analyze agreement between the modalities and a paired t-test was used to determine any significant difference between measurements. RESULTS: For injured clavicles, radiographic measurements significantly overestimated the clavicular length by a mean of 8.2 mm (standard deviation [SD], ± 10.2; confidence interval [CI], 95%) compared to CT-based measurements (p < 0.001). The intraclass correlation was 0.96 for both plain radiograph- and CT-based measurements (p = 0.17). CONCLUSIONS: We found that plain radiograph-based measurements of midshaft clavicle shortening are precise, but inaccurate. When clavicle shortening is considered in the decision to pursue operative management, we do not recommend the use of plain radiograph-based measurements.

Microsurgical Foraminotomy via Wiltse Paraspinal Approach for Foraminal or Extraforaminal Stenosis at L5-S1 Level : Risk Factor Analysis for Poor Outcome

OBJECTIVE: The purpose of this study was to present the outcome of the microsurgical foraminotomy via Wiltse paraspinal approach for foraminal or extraforaminal (FEF) stenosis at L5–S1 level. We investigated risk factors associated with poor outcome of microsurgical foraminotomy at L5–S1 level. METHODS: We analyzed 21 patients who underwent the microsurgical foraminotomy for FEF stenosis at L5–S1 level. To investigate risk factors associated with poor outcome, patients were classified into two groups (success and failure in foraminotomy). Clinical outcomes were assessed by the visual analogue scale (VAS) scores of back and leg pain and Oswestry disability index (ODI). Radiographic parameters including existence of spondylolisthesis, existence and degree of coronal wedging, disc height, foramen height, segmental lordotic angle (SLA) on neutral and dynamic view, segmental range of motion, and global lumbar lordotic angle were investigated. RESULTS: Postoperative VAS score and ODI improved after foraminotomy. However, there were 7 patients (33%) who had persistent or recurrent leg pain. SLA on neutral and extension radiographic films were significantly associated with the failure in foraminotomy (p17.3°) and extension radiographic films (>24°).

Hand Injury Patterns Caused by Different Electric Saws in South Korea

PURPOSE: Electric saw is widely used and patients involved with the tool are increasing. We made efforts to analyze data of saw-related hand injuries. METHODS: Electric saw-related hand injuries that required operation were analyzed retrospectively by reviewing medical charts, clinical photographs and X-ray films from 2009 through 2013. Additionally, we interviewed patients regarding the type of electric saw involved (hand-held/table-mounted) and how the hand was injured. RESULTS: There were 16 male patients with 19 injured fingers and 22 injured tendons. Due to the damaging mechanism of the electric saw, injuries were severe and complex such as tendon, bone defects, fractures and amputations. 4 fingers had open fractures. Separately, 4 were amputated. Non-dominant hands were injured more by hand-held saw, while, dominant hands were damaged more by table-mounted saw. The thumb and index fingers were injured mostly by electric saw. Probability of dominant and non-dominant hand injury depends on the types of electric saw because of the working position when using this tool. CONCLUSION: Hand injuries can be classified according to the type of electronic saw used. Complete understanding of a specific trauma mechanism and the resulting injury patterns is important especially for hand surgeons. Surgeons should take into account the type of electric saw when examining patients. However, the most important step to prevent these types of injuries is to provide all workers with appropriate training and precautions before using the electric saw.

Peligrosidad de los componentes del paquete radiográfico intraoral y líquidos de procesado / Danger of the intraoral radiographic package and developer liquid components

En odontología, para la obtención de imágenes radiográficas intraorales por métodos convencionales, se utilizan paquetes radiográficos que contienen en su interior a la película radiográfica. Luego de la exposición del paquete radiográfico a los rayos X se realiza el procesado, lo cual requiere el uso de líquidos reveladores y fijadores, que son las sustancias químicas que harán posible la visualización de la imagen.Tanto el paquete radiográfico como lo líquidos de procesado presentan en su constitución elementos que, por sus características, pueden ser incluidos enel rubro de “elementos peligrosos” para la salud y para el medio ambiente. En este trabajo de divulgación se pretende realizar un análisis de las características que hacen a la peligrosidad de cada uno de los componentes del paquete radiográfico y de los líquidos —revelador y fijador— usados en el procesado, lo cual es necesario conocer para el manejo seguro y adecuado de este tipo de elementos...

Microbiological contamination in digital radiography: evaluation at the radiology clinic of an educational institution / Contaminação microbiológica em radiografias digitais: avaliação da clínica de radiologia de uma instituição de ensino

The aim of this study was to evaluate the contamination rate of intraand extraoral digital Xray equipment in a dental radiology clinic at a public educational institution. Samples were collected on three different days, at two times in the day: in the morning, before attending patients, and at the end of the day, after appointment hours and before cleaning and disinfection procedures. Samples were collected from the periapical Xray machine (tube head, positioning device, control panel and activator button), the panoramic Xray machine (temporal support, bite block, control panel and activator button), the intraoral digital system (sensor), and the digital system computers (keyboard and mouse). The samples were seeded in different culture media, incubated, and colonyforming units (CFU/mL) counted. Biochemical tests were performed for suspected colonies of Staphylococcus, Streptococcus and Gramnegative bacilli (GNB). Fungi were visually differentiated into filamentous fungi and yeasts. The results indicated the growth of fungi and Staphylococcus from all sampling locations. GNB growth was observed from all sites sampled from the intraoral Xray equipment. On the panoramic unit, GNB growth was observed in samples from activator button, keyboard and mouse. In general, a higher number of CFU/mL was present before use. It can be concluded that more stringent protocols are needed to control infection and prevent Xray exams from acting as vehicle for cross contamination.

O objetivo neste estudo foi avaliar o índice de contaminação dos equipamentos de radiografias digitais intra e extrabucais da clínica de radiologia odontológica de uma instituição pública de ensino. As amostras foram coletadas em três dias distintos, em dois momentos: pela manhã, antes dos atendimentos clínicos, e ao final do dia, após os atendimentos e antes dos procedimen tos de limpeza e desinfecção. As amostras foram coletadas do aparelho de raios X periapical (cabeçote, braço articular, painel de controle e botão disparador); do aparelho de raios X panorâmico (apoio temporal, bloco de mordida, painel de controle e botão disparador); do sistema digital intrabucal (sensor); dos computadores dos sistemas digitais (teclado emouse). As amostras foram semeadas em diferentes meios de cultura e, após incubação, foram contadas as unidades formadoras de colônia (UFC/mL). Testes bioquímicos foram realizados para colônias suspeitas de Staphylococcus, Streptococcus e bastonetes Gram negativos(BGN). Os fungos foram diferenciados visualmente em fungos filamentosos e leveduras. Os resultados indicaram crescimento de fungos e Staphylococcus em todos os locais amostrados. Em relação aos BGN, houve crescimento em todos os locais coletados do equipamento radiográfico intrabucal. No aparelho panorâmico, houve crescimento de BGN apenas no botão disparador, teclado e mouse. De maneira geral, houve maior número de UFC/mL antes do uso. Pode se concluir que é necessário implantar protocolos mais rigorosos de controle de infecção na prática radiológica, evitando que a obtenção de exames radiográficos seja um veículo para contaminação cruzada na FO/UFJF.

Simultaneous Use of Both Bilateral Intralaminar and Pedicle Screws for C2 Stabilization

Four patients underwent stabilization surgery using both bilateral C2 pedicle screw (PS) and intralaminar screw (LS). Neural and vascular injury resulting from incorrect screw placement was assessed using computed tomography (CT). The evaluation of bone union was assessed by lateral flexion-extension X-ray films and CT. The symptoms were improved in all patients. There were no intraoperative complications. Furthermore, there were no cases of neurological worsening or vascular injury from incorrect screw placement. Failure of instrumentation or screw loosening during the follow-up period did not occur in any of the patients. All cases had accomplished bone union at the final follow-up. Theoretically, the stabilization technique using both bilateral C2 PS and LS at the same time can provide more stability than any other single technique. Simultaneous use of both bilateral C2 PS and LS is potentially a good choice for surgical repair.

Relationship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events in dialysis patients

BACKGROUND: Pulmonary hypertension (PHT) is a recently recognized complication of chronic kidney disease. In this study, we investigated the association between PHT, peripheral vascular calcifications (VCs), and major cardiovascular events. METHODS: In this retrospective study, we included 172 end-stage renal disease (ESRD) patients undergoing dialysis [hemodialysis (HD)=84, peritoneal dialysis=88]. PHT was defined as an estimated pulmonary artery systolic pressure >37 mmHg using echocardiography. The Simple Vascular Calcification Score (SVCS) was measured using plain radiographic films of the hands and pelvis. RESULTS: The prevalence of PHT was significantly higher in HD patients (51.2% vs. 22.7%). Dialysis patients with PHT had a significantly higher prevalence of severe VCs (SVCS> or =3). In multivariate analysis, the presence of severe VCs [odds ratio (OR), 2.68], mitral valve disease (OR, 7.79), HD (OR, 3.35), and larger left atrial diameter (OR, 11.39) were independent risk factors for PHT. In addition to the presence of anemia, severe VCs, or older age, the presence of PHT was an independent predictor of major cardiovascular events in ESRD patients. CONCLUSION: The prevalence of PHT was higher in HD patients and was associated with higher rates of major cardiovascular events. Severe VCs are thought to be an independent risk factor for predicting PHT in ESRD patients. Therefore, in dialysis patients with PHT, careful attention should be paid to the presence of VCs and the occurrence of major cardiovascular events.

Aplicabilidade clínica da radiografia digital na Odontologia / The clinical applicability of digital radiography in dentistry

As primeiras radiografias digitais surgiram em 1987. Esta tecnologia é considerada um grande avanço, pois possibilita inúmeras vantagens sobre a radiografia tradicional, por exemplo, redução da dose de exposição aos raios-x, aumentando a segurança e a qualidade do procedimento, além de o custobenefício da radiografia digital ser melhor quando comparada à convencional. Revisão de literatura: As principais vantagens da radiografia digital comparada às radiografias tradicionais são: diminuição da dose de exposição, eliminação do processo químico de revelação/fixação, a possibilidade de manipulação das imagens, a obtenção de novas imagens sem a realização de novas tomadas radiográficas e menor desconforto para o paciente. Objetivos: Este trabalho tem como objetivo, revisar a literatura abordando as vantagens e desvantagens da radiografia digital comparada à radiografia convencional, bem como verificar sua aplicabilidade real na clínica odontológica. Conclusão: O presente trabalho conclui que a radiografia digital possui uma margem de erro menor quando comparada à radiografia convencional, o que leva a diagnósticos fidedignos de situações em região oral e maxilofacial, levando também a um aperfeiçoamento no tratamento...

The first digital radiography came up in 1987. This technology is considered an important achievement, since it allows several advantages on traditional radiography, for example, by reducing the dose of exposure to X-Rays, by increasing the security and the quality of procedure, besides the fact that the cost benefit of digital radiography is better than the conventional one. Literature review: The main advantages of digital radiography when compared to the traditional one are: reduction of exposure dose, elimination of chemical process of revelation/fixation, the possibility of manipulating images and achieving new images without the need of new capture and lower discomfort to the patient. Objectives: The objective of this paper is reviewing the literature, taking into account the advantages and disadvantages of digital radiography when compared to the conventional one, and verifying its applicability in the Dentistry service. Conclusion: The present work concludes that the digital radiography has a lower margin of error than the conventional radiography, what leads to an important diagnosis of oral and maxillofacial region situations, also leading to a an improvement in the treatment...

Digital evaluation of the influence of interruption of the fixation process on radiographic contrast and base-plus-fog density in three commercial brands of radiographic films / Avaliação digital da influência da interrupção da fixação no contraste radiográfico e na densidade base e velamento em três marcas comerciais de filmes radiográficos

Introduction : With the interest in anticipating access to the result of intraoral radiography, the radiographic processing is frequently neglected, compromising image quality. Objective: The aim of this study was to evaluate the influence of interrupting the fixation process on the radiographic contrast and base-plus-fog density (BPFD) in three brands of periapical films. Material and Method: Ninety radiographs were taken of an aluminum stepwedge and a lead plate for each brand, and they were divided according to the time of initial immersion in the fixative in: control group (without interrupting the fixing), 5, 10, 20, 30 and 40 seconds. During processing, films had the fixing stage stopped and were exposed to a negatoscope for 1 minute, then the fixation time of 10 minutes was completed. The radiographs were digitized and exported to Image Tool 3.0.software. Result: Kodak(r) film showed no statistically significant differences between groups, while Agfa(r) film presented difference in BPFD compared with Group 5 seconds, and Dentix(r) film showed statistical difference in all groups in comparison with the control group. Conclusion: Under the conditions studied, Kodak(r) film is not influenced by disruption of fixation as regards BPFD and image contrast, enabling early access to the results of radiographs, whereas Agfa(r) film requires at least 10 seconds of initial fixation, and Dentix(r) film obtains better results when the process of fixation is not interrupted. .

Introdução: Com a preocupação em antecipar o acesso ao resultado de radiografias intrabucais, o processamento radiográfico é muitas vezes negligenciado, comprometendo a qualidade da imagem. Objetivo: O objetivo deste trabalho foi avaliar a influência da interrupção do processo de fixação no contraste radiográfico e na densidade base e velamento (DBV) em 3 marcas comerciais de filmes periapicais. Material e Método: Foram realizadas 90 radiografias de um stepwedge de alumínio e uma placa de chumbo para cada marca, e as mesmas foram divididas de acordo com o tempo de imersão inicial no fixador em: grupo controle (sem interrupção na fixação), 5, 10, 20, 30 e 40 segundos. Durante o processamento, os filmes tiveram a fixação interrompida e foram expostos à luz de um negatoscópio por 1 minuto, e então completaram o tempo de fixação de 10 minutos. As radiografias foram digitalizadas e analisadas no software Image Tool 3.0. Resultado: O filme Kodak(r) não apresentou diferenças estatísticas significantes entre os grupos, enquanto que o filme Agfa(r) apresentou diferença na DBV em relação ao grupo de 5 segundos, e o filme Dentix(r) apresentou diferença estatística em todos os grupos comparando-os ao grupo controle. Conclusão: Sob as condições estudadas, o filme Kodak(r) não sofreu influência da interrupção da fixação na DBV e no contraste da imagem, possibilitando o acesso antecipado ao resultado do exame radiográfico, enquanto que o filme Agfa(r) necessita de pelo menos 10 segundos de fixação inicial e o filme Dentix(r) obtém melhores resultados quando não interrompido o processo de fixação. .

[ effect of developer age the diagnostic accuracy of endodontic files' length]

Radiography has extensive applications in root canal treatment and the developer age plays an important role in making a definite diagnosis. The present study examined the effect of developer age on the diagnostic accuracy of endodontic file length measurement using D-speed, E-speed and E/F-speed films. In this diagnostic study, radiographs were processed weekly by a developer aged for up to 6 weeks. Radiographs were viewed by 5 postgraduate students of endodontics and oral radiology. They determined the file tip position using a 3-point confidence scale. The area under the curve [Az] was calculated and used as a diagnostic accuracy scale. The effects of film type and endodontic file size were analyzed by one-way ANOVA, Tukey's post hoc test and Student's t test. E-speed and D-speed films had similar diagnostic accuracy higher than that of E/F speed film [P<0.0001]. The Az values of D, E and E/F speed films were 0.5882, 0.5538 and 0.3578, in fresh developer, 0.5782, 0.5718 and 0.3498 in 2-week old developer and 0.6196, 0.6724 and 0.2080, in 4-week old developer solution, respectively. Developer age did not decrease the diagnostic accuracy of D and E-speed films but decreased that of E/F films at 4 weeks. Radiographs processed with 6 weeks old developer were not readable. All observers showed higher diagnostic accuracy determining the size of file # 15 than 10 [P<0.0001]. The mean Az values for endodontic file sizes 10 and 15 using fresh, 2-week and 4-week old developers were 0.3984 and 0.6016, 0.3732, and 0.6268 and 0.2774 and 0.7226, respectively. The developer aged for up to 4 weeks did not significantly affect the diag-nostic accuracy of D-speed and E-speed films. E/F speed films cannot be used with de-velopers older than 2 weeks and their usage was associated with lower accuracy compared to E and D-speed films

Occipital Condyle Fracture With Isolated Unilateral Hypoglossal Nerve Palsy

Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.

Diagnostic Utility of Magnetic Resonance Imaging for the Patients with Problems Confined to Cross-Legged Posture / 대한스포츠의학회지

This study was conducted to evaluate the diagnostic utility of magnetic resonance imaging (MRI) for the patients having problems confined to cross-legged posture. The study subjects were 128 cases (male 87.5%) and 120 patients from October 2008 to June 2013. Average age of male patients was 50 years old (range, 21-72 years old), and female 45 years old (range, 18-76 years old). The rate of positive MRI findings was compared according to abnormal physical findings. The average duration of symptoms was 11.7 months. The most frequent complains was on the back (41.9% at rest, 57% when taking the posture). Patrick test was positive for 33.6% of cases, simple radiography was abnormal only for 20% of cases. Bone scan was normal for all 98 cases. Only 21.9% of 128 cases showed abnormal MRI findings which were managed with conservative treatment. Limitation in the range of hip joint motion was not statistically associated with abnormal findings of MRI (p=0.148). Normal Patrick test was associated with normal MRI finding (p=0.001). Among normal cases on both physical and simple bone X-ray film, 88.6% were normal at MRI. In conclusion, for patients with physical complaints from the cross-legged posture, diagnostic utility of MRI is relatively low when they show normal on both physical examination and simple radiography.

Ankle Fracture Associated with Tibia Shaft Fractures

PURPOSE: The purpose of this study is to evaluate the incidence of ankle injury in ipsilateral tibial shaft fractures and to assess the risk factors for ankle injury associated with tibial shaft fractures. MATERIALS AND METHODS: Sixty patients with tibial shaft fractures were enrolled in this retrospective study. The incidence and characteristics of ankle injury were evaluated, and fracture classification, fracture site, and fracture pattern of the tibial shaft fractures were analyzed for assessment of the risk factors for ankle injury combined with tibial shaft fractures. RESULTS: Ankle injury occurred in 20 cases (33%). There were four cases of lateral malleolar fracture, four cases of posterior malleolar fracture, two cases of distal tibiofibular ligament avulsion fracture, and 10 cases of complex injury. Fourteen cases (70%) of 20 cases of ankle injury were diagnosed from x-ray films, and the other six cases were recognized in ankle computed tomography (CT). Ankle injury occurred in 45.1% of distal tibial shaft fractures and found in 41.4% of A type, but there was no statistical significance. Ankle injury was observed in 54% of cases of spiral pattern of tibial shaft fracture and the incidence was statistically higher than 19% of cases of non-spiral pattern tibial shaft fracture. CONCLUSION: Ankle injury was observed in 33% of tibial shaft fractures; however, only 70% could be diagnosed by x-ray. Ankle injury occurred frequently in cases of spiral pattern of tibial shaft fracture, and evaluation of ankle injury with CT is recommended in these cases.

Large Cell Calcifying Sertoli Cell Tumor of the Testis: A Case Study and Review of the Literature

A 24-year-old man was admitted due to an incidentally detected mass in his left testis, which showed radiopaque calcification on plain X-ray film. Left orchiectomy was performed, and the resected testis contained a well-demarcated, hard mass measuring 1.1 cm. Histological analysis revealed that the tumor was composed of neoplastic cells, fibrotic stroma, and laminated or irregularly shaped calcific bodies. The individual cells had abundant eosinophilic or clear cytoplasm with round nuclei, each of which contained one or two conspicuous nucleoli. They were arranged in cords, trabeculae, clusters, and diffuse sheets. There were several foci of intra-tubular growth patterns, with thickening of the basal lamina. Immunohistochemically, the neoplastic cells were positive for S-100 protein and vimentin, focally positive for inhibin alpha, and negative for cytokeratin, CD10, and Melan-A. In addition to reporting this rare case, we also review the relevant literature regarding large cell calcifying Sertoli cell tumors.

Quality of image control in Radiology Clinic using the software / Utilização de um software no controle de qualidade da imagem na Clínica de Radiologia

Objective: To verify the possibility of using the digital imaging as a control of the conditions of automatic radiographic processing. Methods: Radiographic films were standardly exposed and processed, at 4 different temperatures at the beginning of the daily working of a RadiologyClinics, which were digitized and analyzed by Digora for Windows 1.5.1 software, regarding to the radiographic densities, that is, the greylevel. Results: Based on the results it was possible to conclude that there was a ranging in the grey level, because of either the processing degree of the image on the four areas evaluated of each film or at the four temperatures studied which were statistically significant. The characteristic tracings also displayed these differences and the deterioration degree of the image quality due to the consuming of the processing solution. Conclusion: The results indicate that the evaluation of the digital image by Digora for Windows 1.5.1 software is efficient and allows the quality control of the radiographic processing properly, showing that the variation of the grey levels indicate the consuming of action of the processing solutions.

Objetivo: Avaliar a possibilidade de usar a imagem digital como avaliadora das condições de processamento radiográfico automático. Métodos: Usando filmes radiográficos expostos e processados padronizadamente, em 4 temperaturas diferentes no início dos trabalhos diários de umaClínica de Radiologia Odontológica, que foram digitalizadas e observadas pelo software do Digora for Windows 1.5.1, quanto às densidadesradiográficas, ou seja, o nível de cinza. Resultados: As tabelas e gráficos apresentados mostram que existe uma variação do nível de cinza, seja do grau de processamento da imagem nas quatro áreas avaliadas de cada filme e nas quatro temperaturas estudadas que são estatisticamente significantes. Os traçados característicos também mostram estas diferenças e o grau de deterioração da qualidade da imagem pelo desgaste da solução de processamento. Conclusão: Nossos resultados indicam que a avaliação da imagem digital, pelo software do Digora for Windows 1.5.1 é eficiente e permite o controle de qualidade do processamento radiográfico de forma adequada, mostrando que a variação dos níveis de cinza indicam o desgaste da ação dassoluções de processamento.