Development of a simple method to measure static body weight distribution in neurologically and orthopedically normal mature small breed dogs.

BACKGROUND: Objective outcome measures capable of tracking different aspects of functional recovery in dogs with acute intervertebral disc herniation are needed to optimize physical rehabilitation protocols. Normal, pre-injury distribution of body weight in this population is unknown. The aims of this study were to quantify static weight distribution (SWD) using digital scales and to establish the feasibility of different scale methods in neurologically normal, mature, chondrodystrophic small breed dogs predisposed to intervertebral disc herniation. RESULTS: Twenty-five healthy, mature dogs were enrolled with a mean age of 4.6 years (SD 2.7) and a mean total body weight of 11.5 kg (SD 3.6). SWD for the thoracic and pelvic limbs and between individual limbs was acquired in triplicate and expressed as a percentage of total body weight using commercially available digital scales in four combinations: two bathroom, two kitchen (with thoracic and pelvic limbs combined), four bathroom and four kitchen (with limbs measured individually). SWD was also obtained using a pressure sensing walkway for comparison to scale data. Feasibility for each method was determined and coefficients of variation were used to calculate inter-trial variability. Mean SWD values were compared between methods using an ANOVA. The two bathroom scales method had the highest feasibility and lowest inter-trial variability and resulted in mean thoracic and pelvic limb SWD of 63 % (SD 3 %) and 37 % (SD 3 %), respectively. Thoracic limb mean SWD was higher for the PSW compared to any of the scale methods (p < 0.0001). CONCLUSIONS: SWD in a population of healthy chondrodystrophic dogs was simple to obtain using inexpensive and readily available digital scales. This study generated SWD data for subsequent comparison to dogs recovering from acute intervertebral disc herniation.

Prediction of Patient Height and Weight With a 3-Dimensional Camera.

OBJECTIVE: The aim of this study was to determine accuracy of height and weight prediction by a 3-dimensional (3D) camera. METHODS: A total of 453 patients whose computed tomography imaging used a 3D camera from December 19, 2018 to March 19, 2019 were retrospectively identified. An image of each patient was taken before the computed tomography by a 3D camera mounted to the ceiling. Using infrared imaging and machine learning algorithms, patient height and weight were estimated from this 3D camera image. A total of 363 images were used for training. The test set consisted of 90 images. The height and weight estimates were compared with true height and weight to determine absolute and percent error. A value of P < 0.05 indicated statistical significance. RESULTS: There was 2.0% (SD, 1.4) error in height estimation by the 3D camera, corresponding to 3.35 cm (SD, 2.39) absolute deviation (P = 1, n = 86). Weight estimation error was 5.1% (SD, 4.3), corresponding to 3.99 kg (SD, 3.11) absolute error (P = 0.74, n = 90). CONCLUSION: Pictures obtained from a 3D camera can accurately predict patient height and weight.

Exploring the Aortic Root Diameter and Left Ventricle Size Among Lithuanian Athletes.

Background and objectives: Aortic rupture is known as one of the potential causes of sudden cardiac death in athletes. Nevertheless, adaptation strategies for aortic root dilation in athletes vary. The purpose of this study was to investigate aortic root adaptation to physical workload and to determine if aortic roots and left ventricle sizes are contingent upon the physical workload. Materials and Methods: Echocardiography was applied to 151 subjects to measure the aortic root at aortic valve annulus (AA) and at sinus of Valsalva (VS). 122 were athletes (41 females and 81 males) and 29 were non-athletes (14 females and 15 males). Of the 41 female athletes, 32 were endurance athletes, and 9 were strength athletes. From 81 male athletes, 56 were endurance athletes, and 25 were strength athletes. AA and VS mean values for the body surface area were presented as AA relative index with body surface area (rAA) and VS relative index with body surface area (rVS). Left ventricle (LV) measures included LV end-diastolic diameter (LVEDD), interventricular septum thickness in diastole (IVSTd), LV posterior wall thickness in diastole (LVPWTd), LV mass (LVM), LV mass index, and LV end-diastolic diameter index (LVEDDI). Results: Results indicated that VS was higher in female athletes (28.9 ± 2.36 mm) than in non-athletes (27.19 ± 2.87 mm, p = 0.03). On the other hand, rAA was higher in strength athletes (12.19 ± 1.48 mm/m2) than in endurance athletes (11.12 ± 0.99 mm/m2, p = 0.04). Additionally, rVS and rAA were higher in female strength athletes (17.19 ± 1.78 mm/m2, 12.19 ± 1.48 mm/m2) than female basketball players (15.49 ± 1.08 mm/m2, p = 0.03, 10.75 ± 1.06 mm/m2, p = 0.02). No significant differences regarding aortic root were found between male athletes and non-athletes. Statistically significant positive moderate correlations were found between VS and LVEDD, LVM, IVSTd, LVPWTd, rVS, and LVEDDI parameters in all athletes. Conclusion: The diameter of Valsalva sinus was greater in female athletes compared to non-athletes. The rAA mean value for body surface area was greater in female athletes practising strength sports as compared to their counterparts who were practising endurance sports. The diameter of the aortic root at sinuses positively correlated with the LV size in all athletes.

Accuracy of weight estimation by the Broselow tape is substantially improved by including a visual assessment of body habitus.

BackgroundThe Broselow tape (BT) has been shown to estimate weight poorly primarily because of variations in body habitus. The manufacturers have suggested that a visual assessment of habitus may be used to increase its performance. This study evaluated the ability of habitus-modified models to improve the accuracy thereof.MethodsA post hoc analysis of prospectively collected data from four hospitals in Johannesburg, South Africa, on a population of 1,085 children. Sixteen a priori models generated a modified weight estimation or drug dose based on the BT weight and a gestalt assessment of habitus.ResultsThe habitus-modified method suggested by the manufacturer did not improve the accuracy of the BT. Five dosing and four weight-estimation models were identified that markedly improved dosing and weight estimation accuracy, respectively. The best dosing model improved dosing accuracy (doses within 10% of correct dose) from 52.0 to 69.6% and reduced critical dosing errors from 16.5 to 4.3%. The best weight-estimation model improved accuracy from 59.4 to 81.9% and reduced critical errors from 11.8 to 1.9%.ConclusionThe accuracy of the BT as a drug-dosing and weight-estimation device can be substantially improved by including an appraisal of body habitus in the methodology.

Accuracy of pre-interventional computed tomography angiography post-processing software and extravascularly calibrated devices to determine vessel diameters: comparison with an intravascularly located calibrated catheter.

Background Accurate vessel sizing might affect treatment outcome of endovascular therapy. Purpose To compare accuracy of peripheral vessel diameter measurements using pre-interventional computed tomography angiography post processing software (CTA-PPS) and extravascularly located calibrated devices used during digital subtraction angiography (DSA) with an intravascular scaled catheter (SC). Material and Methods In 33 patients (28 men, mean age = 72 ± 11 years) a SC was used during DSA of the femoro-popliteal territory. Simultaneously, one scaled radiopaque tape (SRT) was affixed to the lateral thigh, one scaled radiopaque ruler (SRR) was positioned on the angiography table. For each patient, diameters of five anatomic landmarks were measured on DSA images after calibration using different scaled devices and CTA-PPS. Diameters were compared to SC (reference) and between groups of non-obese (NOB) and obese (OB) patients. Results In total, 660 measurements were performed. Compared to the reference, SRT overestimated the diameter by 1.2% (range = -10-12, standard deviation [SD] = 4.1%, intraclass correlation coefficient [ICC] = 0.992, 95% confidence interval [CI] = 0.989-0.992, P = 0.01), the SRR and CTA-PPS underestimated it by 21.3% (range = 1-47, SD = 9.4%, ICC = 0.864, 95% CI = 0.11-0.963, P = 0.08) and 3.2% (range = 17-38, SD = 9.7%, ICC = 0.976, 95% CI = 0.964-0.983, P = 0.01), respectively. Underestimation using the SRR was greatest in the proximal superficial-femoral artery (31%) and lowest at the P2 level of the popliteal artery (15%). In the NOB group, diameter overestimation of the SRT was 0.8% (range = 4-7, SD = 4.2%, B = 0.071, 95% CI = 0.293-0.435, P = 0.08) compared to the OB group of 1.6% (range = -7-4, SD = 2.9%, B = 0.010, 95% CI = 0.474-0.454, P = 0.96). Diameter underestimation of the SRR was 17.3% (range = 13-21, SD = 3.1%, B = 0.946, 95% CI = 0.486-1.405, P = 0.002) in the NOB group, 23.3% (range = 11-36, SD = 6.6%, B = 0.870, 95% CI = 0.268-1.472, P = 0.007) in the OB group. Conclusion For calibrated measurements SRT and CTA-PPS prove accurate compared to the reference, while SRR does not. Obesity has a significant impact on underestimation of diameter if SRR is used.

Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children.

BACKGROUND: The use of a length/weight-based tape (LBT) for equipment size and drug dosing for pediatric patients is recommended in a joint statement by multiple national organizations. A new system, known as Handtevy™, allows for rapid determination of critical drug doses without performing calculations. OBJECTIVE: To compare two LBT systems for dosing errors and time to medication administration in simulated prehospital scenarios. METHODS: This was a prospective randomized trial comparing the Broselow Pediatric Emergency Tape™ (Broselow) and Handtevy LBT™ (Handtevy). Paramedics performed 2 pediatric simulations: cardiac arrest with epinephrine administration and hypoglycemia mandating dextrose. Each scenario was repeated utilizing both systems with a 1-year-old and 5-year-old size manikin. Facilitators recorded identified errors and time points of critical actions including time to medication. RESULTS: We enrolled 80 paramedics, performing 320 simulations. For Dextrose, there were significantly more errors with Broselow (63.8%) compared to Handtevy (13.8%) and time to administration was longer with the Broselow system (220 seconds vs. 173 seconds). For epinephrine, the LBTs were similar in overall error rate (Broselow 21.3% vs. Handtevy 16.3%) and time to administration (89 vs. 91 seconds). Cognitive errors were more frequent when using the Broselow compared to Handtevy, particularly with dextrose administration. The frequency of procedural errors was similar between the two LBT systems. CONCLUSION: In simulated prehospital scenarios, use of the Handtevy LBT system resulted in fewer errors for dextrose administration compared to the Broselow LBT, with similar time to administration and accuracy of epinephrine administration.

Portable A-Mode Ultrasound for Body Composition Assessment in Adolescents.

OBJECTIVES: Ultrasound (US) imaging is a low-cost, highly feasible alternative method for monitoring the nutritional status of a population; however, only a few studies have tested the body composition agreement between US and reference standard methods, especially in adolescents. The purposes of this study were to assess the agreement of portable US with a reference standard method, dual-energy x-ray absorptiometry (DXA), for body fat percentage (BF%) in adolescents and to verify whether the use of a new mathematical model, based on the anatomic thickness obtained by US, is capable of improving BF% prediction. METHODS: This research was a descriptive study. Measures of total body mass, BF% on DXA, and BF% on US were collected from 105 adolescents. RESULTS: The participants included 71 male adolescents (median age ± interquartile range, 14.0 ± 2.0 years) and 34 female adolescents (13.0 ± 2.3 years). Ultrasound yielded significantly lower BF% values than DXA for male (mean ± SD, US, 9.6% ± 6.6%; DXA, 20.0% ± 7.2%; R= 0.848; P< .05) and female (US, 22.5% ± 5.7%; DXA, 30.3% ± 4.9%; R = 0.495; P < .05) participants. In addition, Bland-Altman analysis showed low concordance. When a multivariate regression was tested, the results improved for both sexes (US, 20.3% ± 4.6%; R= 0.848; P= .503) and female participants (US, 29.0% ± 5.7%; R = 0.712; P = .993) with a standard estimate of error of 1.57%. CONCLUSIONS: This study has shown that US applied in a specific regression for BF% prediction in adolescents has a strong correlation with DXA as well as concordance with Bland-Altman analysis.

Determination of the appropriate sizes of oropharyngeal airways in adults: correlation with external facial measurements: A randomised crossover study.

BACKGROUND: Two external facial measurements have been recommended as reference criteria for estimating appropriate oropharyngeal airway sizes: the distances between the maxillary incisors to the angle of the mandible, and that from the corner of the mouth to the angle of the mandible. OBJECTIVE: To compare the two guidelines and to determine the optimal external facial measurements for the selection of an appropriately sized airway in adults. DESIGN: Randomised crossover study. SETTING: Operating theatres in a university hospital. PATIENTS: A total of 113 patients requiring tracheal intubation for general anaesthesia. INTERVENTIONS: Two oropharyngeal airway sizes were selected on the basis of two external facial measurements (tip of the upper central maxillary incisors to the angle of the mandible and corner of the mouth to the angle of the mandible). After assessing manual and pressure-controlled ventilation without an airway, the adequacy of ventilation with each oropharyngeal airway was assessed in a similar manner. Before changing the oropharyngeal airway, the view at the distal end of each airway was evaluated using endoscopy via a fibreoptic bronchoscope. MAIN OUTCOME MEASURES: Ventilation parameters and the endoscopic views at the distal ends of the airways were assessed. RESULTS: In the maxillary incisors to the angle of the mandible group, there was clear manual ventilation through the oropharyngeal airway in all patients, whereas partially obstructed ventilation was observed in 6% of patients in the corner of the mouth to the angle of the mandible group. In the maxillary incisors to the angle of the mandible group, mechanical ventilation through the oropharyngeal airway was adequate in all patients but in the corner of the mouth to the angle of the mandible group, inadequate ventilation was observed in 7% patients. In the maxillary incisors to the angle of the mandible group, the endoscopy did not identify any patient with complete obstruction of the airway by the tongue but in the corner of the mouth to the angle of the mandible group, 40% of patients had complete obstruction by the tongue. In the maxillary incisors to the angle of the mandible group, the tip of the airway passed beyond the tip of the epiglottis in 22% of patients, in contrast, none of the airways in the corner of the mouth to the angle of the mandible group passed beyond the tip of the epiglottis. CONCLUSION: With regard to adequate ventilation in conjunction with an acceptable endoscopic view, an oropharyngeal airway whose size is based upon the distance from the maxillary incisors to the angle of the mandible is more advantageous than if based upon the distance from the corner of the mouth to the angle of the mandible. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01945411. The clinical trial was registered before patient enrolment.

Assessment of Lumbar Spine Height Following Sustained Lumbar Extension Posture: Comparison Between Musculoskeletal Ultrasonography and Stadiometry.

OBJECTIVES: The purpose of this study was to correlate sitting height measured by stadiometry with lumbar spine height (LSH) modifications measured by musculoskeletal ultrasonography (MSU). METHODS: Eighteen healthy young adults were recruited for this study (mean age: 21.5 ± 1.5 years). All subjects were tested in the following sequence: (1) lying supine for 10 minutes, (2) sitting under loaded (9.5 kg) and unloaded conditions for 5 minutes each, (3) lying supine for 15 minutes with passive lumbar extension, and (4) sitting unloaded for 5 minutes. Both stadiometry and MSU measurements were taken after each step of the testing sequence. RESULTS: Following the loaded sitting step, sitting height (measured by stadiometry) decreased by 3.4 ± 1.6 mm, whereas following sustained lumbar extension, sitting height increased by 5.4 ± 3.5 mm (P < .05). Following loaded sitting and sustained lumbar extension, LSH decreased by 3.8 ± 1.7 mm and increased by 6.2 ± 4.1 mm, respectively (P < .05). On the basis of the mean differences (between the different steps of the testing sequence), the mean correlation coefficient and the mean coefficient of determination between stadiometry and MSU measurements were calculated at 0.93 ± 0.07 and 0.88 ± 0.13, respectively, and no statistical differences were observed (P > .05). CONCLUSIONS: In vivo measurements of sitting height changes, measured using stadiometry, were strongly correlated with LSH changes, measured using ultrasonography.

Weight estimation in an inner-city pediatric ED: the effect of obesity.

BACKGROUND AND OBJECTIVE: Weight estimation for pediatric resuscitation occurs frequently in emergency departments. Historically, different approaches to estimation have been studied with varied results. With increasing obesity rates among inner-city children, this study aims to determine the best method for pediatric weight estimation in our population. METHODS: This is a prospective, nonblinded, observational study. A total of 324 patients (aged 1 month to 12 years) were enrolled in the study to exceed sample size calculations. The accuracy of 4 methods for weight estimation--the Broselow tape, advanced pediatric life support formulas, the PAWPER tape, and mid-arm circumference formula--were compared across age ranges and body sizes to determine the most appropriate method for our population. RESULTS: In this inner-city population, 32% of the patients 2 to 12 years of age were found to be overweight or obese. This rate increased to 41% for patients 6 to 12 years of age. In this setting, the PAWPER tape outperformed the other 3 methods, estimating patients' weight within ±5% of actual weight in 35.2% of our cohort. When compared with the other 3 methods tested, the PAWPER tape was statistically superior with a P value less than .02 in each case. CONCLUSION: Each of the methods tested in our population performed poorly. Current methods for weight estimation should be used with caution, especially for populations with an increased prevalence of obesity. Efforts should be dedicated to improving or deriving new methods for weight estimation that perform better in this vulnerable population.

Use of the Broselow tape in a Mexican emergency department.

BACKGROUND: The Broselow tape is one method for rapid weight estimation in pediatric patients undergoing resuscitation, but it does not perform equally in all populations. To date, we are unaware of any study evaluating its use in a Latin American population. OBJECTIVE: To investigate the accuracy of the Broselow tape in a Mexican emergency department (ED). METHODS: We conducted a prospective, observational study of children presenting to a Mexican ED. Patient weight was estimated using the Broselow tape and the estimate compared to their weight measured on a scale. Researchers were blinded to scale weight and Broselow categories. For analysis, the Broselow tape's nine color zones were divided into three weight categories. RESULTS: Of 815 subjects, 356 (43.7%) were female. In children weighing <10 kg, the tape tended to underestimate weight, whereas it overestimated weight in the other two weight categories. The mean percentage difference between the actual weight and the Broselow tape-predicted weight was <3% in each category, although it differed significantly across the three weight categories. Accuracy of the predicted weight to within 10% of actual weight was lowest for children weighing <10 kg, at 46.2% (confidence interval [CI] ± 6.4%), and greatest for those in the 10-18-kg weight category, at 64.1% (CI ± 5.1%). However, the correlation of color zones predicted by both methods was highest for subjects <10 kg at 64.4% (CI ± 6.1%). It was significantly lower in the other weight categories at 54.5% (CI ± 5.3) for subjects weighing 10-18 kg, and 50.1% (CI ± 6.4%) for subjects weighing >18 kg. The percentage of children for whom the color code differed by two or more categories was <4% overall and for each weight category. CONCLUSION: The Broselow tape-estimated weight was different from the scale weight by more than 10% in a substantial percentage of Mexican children. Nevertheless, the mean percentage difference was <3%, and Broselow tape color zone estimation was accurate in the majority of subjects, suggesting its use would result in clinically appropriate dosing and equipment estimations. Further research is needed to validate its use in this clinical setting.

Joint gap measurement in total knee arthroplasty using a tensor device with the same articulating surface as the prosthesis.

BACKGROUND: We developed a new tensor to measure the joint gap throughout knee flexion during total knee arthroplasty (TKA). This tensor has the same articular shape as that of the tibial liner, including the post structure and the curvature of femorotibial articular surface, to measure the gap intraoperatively under the same conditions as after TKA. The present study aimed to examine the precision of the new tensor for gap measurement after implantation. METHODS: We performed TKA using the modified gap technique in four cadaveric knees and measured the gaps using the new tensor. The intra-observer and inter-observer error of the tensor was analyzed using 168 measurements of the gaps as determined at least twice by two surgeons. In addition, the gaps in rotating-platform posterior-stabilized TKA were measured at seven positions with the knee bending from extension to full flexion. RESULTS: The inter-observer and intra-observer errors were 0.8 and 0.3 mm, respectively, indicating precise and reproducible gap measurement. The gaps before implantation in reduced patellar position were 12.1 mm at extension and 12.5 mm at 90° flexion. The gaps after implantation were 9.1, 12.9, 13.1, 13.5, 13.8, 13.3, and 10.1 mm at 0°, 30°, 45°, 60°, 90°, 120°, and full flexion, respectively. CONCLUSIONS: The new tensor provides precise and reproducible measurements. Although the joint gap before implantation was parallel and equal at extension and 90° flexion, the joint gap after implantation was variable throughout knee flexion. This feature of the gap should be considered during the operation.

Effectiveness of female community health volunteers in the detection and management of low-birth-weight in Nepal.

INTRODCTION: Low birth weight (LBW) is a major risk factor for neonatal death. However, most neonates in low-income countries are not weighed at birth. This results in many LBW infants being overlooked. Female community health volunteers (FCHVs) in Nepal are non-health professionals who are living in local communities and have already worked in a field of reproductive and child health under the government of Nepal for more than 20 years. The effectiveness of involving FCHVs to detect LBW infants and to initiate prompt action for their care was studied in rural areas of Nepal. METHODS: FCHVs were tasked with weighing all neonates born in selected areas using color-coded spring scales. Supervisors repeated each weighing using electronic scales as the gold standard comparator. Data on the relative birth sizes of the infants, as assessed by their mothers, were also collected and compared with the measured weights. Each of the 205 FCHVs involved in the study was asked about the steps that she would take when she came across a LBW infant, and knowledge of zeroing a spring scale was also assessed through individual interviews. The effect of the background social characteristics of the FCHVs on their performance was examined by logistic regression. This study was nested within a community-based neonatal sepsis-management intervention surveillance system, which facilitated an assessment of the performance of the FCHVs in weighing neonates, coverage of FCHVs' visits, and weighing of babies through maternal interviews. RESULTS: A total of 462 babies were weighed, using both spring scales and electronic scales, within 72 hours of birth. The prevalence of LBW, as assessed by the gold standard method, was 28%. The sensitivity of detection of LBW by FCHVs was 89%, whereas the sensitivity of the mothers' perception of size at birth was only 40%. Of the 205 FCHVs participating in the study, 70% of FCHVs understood what they should do when they identified LBW and very low birth weight (VLBW) infants. Ninety-six per cent could describe how to zero a scale and approximately 50% could do it correctly. Seventy-seven per cent of FCHVs weighed infants at least once during the study period, and 19 of them (12%) miscategorized infant weights. Differences were not detected between the background social characteristics of FCHVs who miscategorized infants and those who did not. On the basis of maternal reporting, 67% of FCHVs who visited infants had weighed them. CONCLUSIONS: FCHVs are able to correctly identify LBW and VLBW infants using spring scales and describe the correct steps to take after identification of these infants. Use of FCHVs as newborn care providers allows for utilization of their logistical, geographical, and cultural strengths, particularly a high level of access to neonates, that can complement the Nepalese healthcare system. Providing additional training to and increasing supervision of local FCHVs regarding birth weight measurement will increase the identification of high-risk neonates in resource-limited settings.

Geometric analysis of medio-lateral position of patella: a new measuring tool.

BACKGROUND: Evaluation of medio-lateral position of patella is necessary for diagnosis and treatment of patellofemoral diseases. OBJECTIVE: In the present study, we aimed to evaluate medio-lateral patellar position differences and to define a new practical measuring tool which enables us to analyze relationships of the points at the knee. MATERIALS AND METHODS: Total of 120 healthy volunteers (60 men and 60 women) were included in our study and both of their knees were measured. In the research, the gender groups and right-left differences were evaluated. In the measurements, a four-lever measuring tool designed for this study was used. The four anatomic points of the knee which are center of patella, epicondylus lateralis, epicondylus medialis and middle point of tuberositas tibiae were used. RESULTS: While patella is 76% lateral in the right knee, it is 90% lateral in the left knee in men. As for woman, while it is 50% lateral in the right-knee, it is 30% lateral in the left-knee. In medio-lateral patellar position, while bilateral asymmetry is 28% in men, it is 50% in women. In measurements of knees of women and men, significant differences were detected both in the right and left knees ( P < 0.05 and P < 0.001). CONCLUSION: The patellofemoral order differences between men and women can explain anatomic reasons of patellofemoral diseases, which are encountered more in women than men.

Anthropometric protocols for the construction of new international fetal and newborn growth standards: the INTERGROWTH-21st Project.

The primary aim of the INTERGROWTH-21(st) Project is to construct new, prescriptive standards describing optimal fetal and preterm postnatal growth. The anthropometric measurements include the head circumference, recumbent length and weight of the infants, and the stature and weight of the parents. In such a large, international, multicentre project, it is critical that all study sites follow standardised protocols to ensure maximal validity of the growth and nutrition indicators used. This paper describes, in detail, the selection of anthropometric personnel, equipment, and measurement and calibration protocols used to construct the new standards. Implementing these protocols at each study site ensures that the anthropometric data are of the highest quality to construct the international standards.

Ultrasound methodology used to construct the fetal growth standards in the INTERGROWTH-21st Project.

A unified protocol is essential to ensure that fetal ultrasound measurements taken in multicentre research studies are accurate and reproducible. This paper describes the methodology used to take two-dimensional, ultrasound measurements in the longitudinal, fetal growth component of the INTERGROWTH-21(st) Project. These standardised methods should minimise the systematic errors associated with pooling data from different study sites. They represent a model for carrying out similar research studies in the future.

Using the Microsoft Kinect for patient size estimation and radiation dose normalization: proof of concept and initial validation.

Monitoring patients' imaging-related radiation is currently a hot topic, but there are many obstacles to accurate, patient-specific dose estimation. While some, such as easier access to dose data and parameters, have been overcome, the challenge remains as to how accurately these dose estimates reflect the actual dose received by the patient. The main parameter that is often not considered is patient size. There are many surrogates-weight, body mass index, effective diameter-but none of these truly reflect the three-dimensional "size" of an individual. In this work, we present and evaluate a novel approach to estimating patient volume using the Microsoft Kinect™, a combination RGB camera-infrared depth sensor device. The goal of using this device is to generate a three-dimensional estimate of patient size, in order to more effectively model the dimensions of the anatomy of interest and not only enable better normalization of dose estimates but also promote more patient-specific protocoling of future CT examinations. Preliminary testing and validation of this system reveals good correlation when individuals are standing upright with their arms by their sides, but demonstrates some variation with arm position. Further evaluation and testing is necessary with multiple patient positions and in both adult and pediatric patients. Correlation with other patient size metrics will also be helpful, as the ideal measure of patient "size" may in fact be a combination of existing metrics and newly developed techniques.

Pediatric emergencies: preparing at triage using height and weight.

Obtaining an actual weight is critical to accurate medication dosing. Knowledge of length/height is critical to equipment sizing. Rapid and accurate measurement of both upon arrival at the emergency department increases patient safety and staff comfort in the case of a decompensating child requiring resuscitation. Having a process in place that works with the layout, medical record, and budget of the department increases safety for the patient and may improve outcomes, and if the process is led by staff champions, acceptance of the process may be faster. Regardless of the actual method, patient safety and staff satisfaction can be improved with a simple process that prepares for an emergency in pediatric care.

In situ leg length measurement technique in hip arthroplasty.

In situ femoral preparation refers to implanting a femoral component before the femoral neck osteotomy and without dislocating the hip joint, which allows the implanted femoral component to be used to measure leg length and offset. One hundred hip arthroplasty surgeries among 93 patients were compared with a control group of 15 patients. A modular neck femoral component was implanted in a technique similar to implanting a femoral nail. The differences between the in situ measurements and the preoperative and postoperative radiograph measurements averaged -0.1 mm for leg length (r = 0.89) and -0.37 mm for offset (r = 0.57). In situ leg length measurement allows accurate measurement of leg length and offset and guides surgeons in selecting appropriate modular components to attain a near anatomical hip arthroplasty.