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2.
Radiol Technol ; 93(6): 532-543, 2022.
Article in English | MEDLINE | ID: mdl-35790302

ABSTRACT

PURPOSE: To examine whether radiologic technologists' perceptions of imaging appropriateness differed based on their primary imaging modality, work shift, shift length, and primary practice type. METHODS: A national, cross-sectional study was conducted in the fourth quarter of 2019 using a simple, randomized sample of American Society of Radiologic Technologists (ASRT) members. Study participants were employed in health care settings in radiography, computed tomography (CT), mammography, or radiology leadership. Seven potential reasons for inappropriate imaging procedures (ie, patient expectations, provide patient with a feeling of being taken seriously, lack of time, expectations from relatives, compensation for insufficient clinical examination, normal findings would reassure the patient, and fear of lawsuits) were evaluated for relationships with their primary imaging modality, work shift, shift length, and primary practice type. RESULTS: Disparities in perceived reasons affecting imaging appropriateness were found. Providing the patient with a feeling of being taken seriously was related to primary practice type (P = .022). Lack of time was related to primary imaging modality (P = .005) and primary practice type (P = .006). Expectations from relatives was related to primary imaging modality (P = .016) and primary practice type (P = .027). Compensation for insufficient clinical examination was related to primary imaging modality (P < .001), shift length (P = .011), work shift (P = .002), and primary practice type (P < .001). Fear of lawsuits was related to primary imaging modality (P = .001)) and work shift (P = .002). DISCUSSION: The study reveals that radiologic technologists' perceptions of patient-centered factors and defensive medicine-related factors differ among imaging modalities, shift types, and practice settings. However, more research is required to determine why radiologic technologists perceive these reasons to be present, investigate whether providers feel similarly, and determine perceptual alignment with evidence-based guidelines. CONCLUSION: The findings suggest that attention should focus on the appropriateness of CT imaging procedures performed in hospitals during night shifts.


Subject(s)
Health Personnel , Medical Overuse , Radiography , Radiology , Technology, Radiologic , Cross-Sectional Studies , Diagnostic Imaging/standards , Humans , Leadership , Mammography , Medical Overuse/statistics & numerical data , Radiography/standards , Radiology/standards , Technology, Radiologic/standards , Tomography, X-Ray Computed , United States
4.
Pediatr Infect Dis J ; 41(1): 31-36, 2022 01 01.
Article in English | MEDLINE | ID: mdl-34524234

ABSTRACT

BACKGROUND: Establishing the etiology of community-acquired pneumonia (CAP) in children at admission is challenging. Most of the admitted children with CAP receive antibiotics. We aimed to build and validate a diagnostic tool combining clinical, analytical and radiographic features to differentiate viral from bacterial CAP, and among bacterial CAP, typical from atypical bacteria. METHODS: Design-observational, multi-center, prospective cohort study was conducted in 2 phases. Settings: 24 secondary and tertiary hospitals in Spain. Patients-A total of 495 consecutive hospitalized children between 1 month and 16 years of age with CAP were enrolled. Interventions-A score with 2 sequential steps was built (training set, 70% patients, and validation set 30%). Step 1 differentiates between viral and bacterial CAP and step 2 between typical and atypical bacterial CAP. Optimal cutoff points were selected to maximize specificity setting a high sensitivity (80%). Weights of each variable were calculated with a multivariable logistic regression. Main outcome measures-Viral or bacterial etiology. RESULTS: In total, 262 (53%) children (median age: 2 years, 52.3% male) had an etiologic diagnosis. In step 1, bacterial CAPs were classified with a sensitivity = 97%, a specificity = 48%, and a ROC's area under the curve = 0.81. If a patient with CAP was classified as bacterial, he/she was assessed with step 2. Typical bacteria were classified with a sensitivity = 100%, a specificity = 64% and area under the curve = 0.90. We implemented the score into a mobile app named Pneumonia Etiology Predictor, freely available at usual app stores, that provides the probability of each etiology. CONCLUSIONS: This 2-steps tool can facilitate the physician's decision to prescribe antibiotics without compromising patient safety.


Subject(s)
Community-Acquired Infections/diagnosis , Community-Acquired Infections/etiology , Mobile Applications/standards , Pneumonia, Bacterial/diagnosis , Pneumonia, Viral/diagnosis , Adolescent , Child , Child, Preschool , Community-Acquired Infections/microbiology , Community-Acquired Infections/virology , Female , Humans , Infant , Logistic Models , Male , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Prospective Studies , Radiography/methods , Radiography/standards
5.
Sci Rep ; 11(1): 23262, 2021 12 01.
Article in English | MEDLINE | ID: mdl-34853409

ABSTRACT

The aims of this study were to (1) assess reliability of leg length discrepancy (LLD) measurements at different anatomical landmarks, (2) longitudinally investigate LLD in patients within the first year following total hip arthroplasty (THA) and to (3) correlate changes in LLD with functional outcome. Ninety-nine patients with short stem THA (53.3% males, mean age: 61.0 ± 8.1 years) were prospectively included. Upright pelvic anteroposterior (a.p.) radiographs taken at 6 timepoints (preoperatively, discharge, 6, 12, 24, 52 weeks postoperatively) were used to assess LLD at 5 anatomical landmarks (iliac crest, upper sacroiliac joint, lower sacroiliac joint, tear drop figure, greater trochanter). WOMAC and Harris Hip Score (HHS) were obtained preoperatively and at 6 and 52 weeks. LLD measures significantly increased in the initial phase following THA, from discharge to 6 weeks postoperatively and remained constant thereafter. Documentation of LLDs is dependent on measurement site: LLDs varied significantly between trochanter and iliac crest to tear drop figure (p < 0.001). Functional assessments did not correlate with the occurrence of LLDs [WOMAC (p = 0.252); HHS (p = 0.798)]. Radiographic assessment of LLD following THA may not be performed early postoperatively, as measurements appear to inaccurately reflect actual LLDs at this time, potentially due incomplete leg extension and/or inhibited weight-bearing.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Leg/anatomy & histology , Leg/physiology , Radiography/standards , Aged , Female , Femur/surgery , Humans , Leg/surgery , Leg Length Inequality/diagnostic imaging , Male , Middle Aged , Minimally Invasive Surgical Procedures , Observer Variation , Postoperative Complications , Postoperative Period , Prospective Studies , Reproducibility of Results , Time Factors , Treatment Outcome
6.
Pediatr Infect Dis J ; 40(12): 1064-1069, 2021 Dec 01.
Article in English | MEDLINE | ID: mdl-34269322

ABSTRACT

BACKGROUND: Accessibility to chest radiography remains a major challenge in high burden and low-income countries. The World Health Organization (WHO) guidelines acknowledge that for child contacts under 5 years, a negative symptom-based screening is sufficient to exclude active tuberculosis (TB), but in child contacts older than 5 years, a chest radiograph should be considered. We performed a systematic review and meta-analysis to assess the performance of symptom-based screening compared with chest radiography in household contacts under 15 years in low-income and middle-income countries. METHODS: Screening articles published prior 1 October 2020 and data extraction were performed by 2 independent reviewers. The primary outcome was the concordance between symptom screening and chest radiography using the prevalence adjusted bias adjusted kappa coefficient (PABAK) and the proportion of asymptomatic children with negative chest radiography. The analysis was stratified by age group. RESULTS: Of 639 identified articles, 10 were included. PABAK varied between 0.09 and 0.97 and between 0.22 and 0.98, in children less than 5 years and 5-14 years, respectively. The pooled proportion of children with both non-TB suggestive symptoms and chest radiography findings was 98.7% (96.9-99.8) in children less than 5 years and 98.1% (93.8-100) in children of age 5-14 years. CONCLUSIONS: Despite low concordance between symptom-based screening and chest radiography, most children without TB suggestive symptoms did not have chest radiography findings suggestive of TB. These results suggest that a negative symptom screening is sufficient to rule out active TB, supporting the WHO recommendation to use symptom-based screening alone when chest radiography is not available.


Subject(s)
Mass Screening/methods , Mass Screening/standards , Radiography/standards , Tuberculosis, Pulmonary/diagnostic imaging , Tuberculosis/diagnostic imaging , Child , Humans , Poverty
7.
Spine (Phila Pa 1976) ; 46(15): 1033-1038, 2021 Aug 01.
Article in English | MEDLINE | ID: mdl-34228695

ABSTRACT

STUDY DESIGN: Retrospective observational study. OBJECTIVE: To assess the accuracy and reliability of standing lateral lumbar radiographs for measurements of spinopelvic parameters, compared with whole-spine EOS® images. SUMMARY OF BACKGROUND DATA: Lateral lumbar radiographs are commonly used for measurements of spinopelvic parameters. However, variable magnifications by fan-beam x-ray projection at margins may cause measurement errors. METHODS: Fifty consecutive patients with standing lateral lumbar radiographs and whole-spine EOS® images were retrospectively reviewed from March to July in 2019. Two orthopedic surgeons (observers) independently measured the spinopelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) on the computers. These spinopelvic parameters of each patient were measured twice on both lateral lumbar radiograph and EOS® image by two observers with the usage of Surgimap software. The measurement difference and agreement of each parameter value between lateral lumbar radiographs and EOS® images were analyzed by paired t test and the interclass correlation coefficient (ICC) respectively. Intra- and inter-observer's reliabilities of both imaging methods were assessed by ICC. RESULTS: The measurement difference of each spinopelvic parameter on EOS® images and lateral lumbar radiographs was less than 1° on average. Only the measurement difference of PI value revealed statistically significant (P = 0.020) with 0.9° discrepancy (95% confidential interval: 0.2-1.6), which indicated no clinical significance. The ICC values of lateral lumbar radiographs and EOS® images were more than 0.870 (range, 0.872-0.976), thus showed good to excellent measurement agreement between both imaging methods. All the ICC values for evaluating intra- and inter-observer reliability were greater than 0.960 (range, 0.963-0.993), indicating excellent reliability for observer's measurements. CONCLUSION: Measurements of spinopelvic parameters (PI, PT, SS, and LL) on standing lateral lumbar radiographs are accurate and reliable, which are comparable to whole-spine EOS® images.Level of Evidence: 3.


Subject(s)
Lumbosacral Region , Radiography/standards , Standing Position , Humans , Lumbosacral Region/anatomy & histology , Lumbosacral Region/diagnostic imaging , Reproducibility of Results , Retrospective Studies
8.
J Clin Neurosci ; 89: 297-304, 2021 Jul.
Article in English | MEDLINE | ID: mdl-34119284

ABSTRACT

This retrospective cohort study describes adult cervical deformity(ACD) patients with Ames-ACD classification at baseline(BL) and 1-year post-operatively and assesses the relationship of improvement in Ames modifiers with clinical outcomes. Patients ≥ 18yrs with BL and post-op(1-year) radiographs were included. Patients were categorized with Ames classification by primary deformity descriptors (C = cervical; CT = cervicothoracic junction; T = thoracic; S = coronal) and alignment/myelopathy modifiers(C2-C7 Sagittal Vertical Axis[cSVA], T1 Slope-Cervical Lordosis[TS-CL], Horizontal Gaze[Horiz], mJOA). Univariate analysis evaluated demographics, clinical intervention, and Ames deformity descriptor. Patients were evaluated for radiographic improvement by Ames classification and reaching Minimal Clinically Important Differences(MCID) for mJOA, Neck Disability Index(NDI), and EuroQuol-5D(EQ5D). A total of 73 patients were categorized: C = 41(56.2%), CT = 18(24.7%), T = 9(12.3%), S = 5(6.8%). By Ames modifier 1-year improvement, 13(17.8%) improved in mJOA, 26(35.6%) in cSVA grade, 19(26.0%) in Horiz, and 15(20.5%) in TS-CL. The overall proportion of patients without severe Ames modifier grades at 1-year was as follows: 100% cSVA, 27.4% TS-CL, 67.1% Horiz, 69.9% mJOA. 1-year post-operatively, severe myelopathy(mJOA = 3) prevalence differed between Ames-ACD descriptors (C = 26.3%, CT = 15.4%, T = 0.0%, S = 0.0%, p = 0.033). Improvement in mJOA modifier correlated with reaching 1-year NDI MCID in the overall cohort (r = 0.354,p = 0.002). For C descriptors, cSVA improvement correlated with reaching 1-year NDI MCID (r = 0.387,p = 0.016). Improvement in more than one radiographic Ames modifier correlated with reaching 1-year mJOA MCID (r = 0.344,p = 0.003) and with reaching more than one MCID for mJOA, NDI, and EQ-5D (r = 0.272,p = 0.020). In conclusion, improvements in radiographic Ames modifier grades correlated with improvement in 1-year postoperative clinical outcomes. Although limited in scope, this analysis suggests the Ames-ACD classification may describe cervical deformity patients' alignment and outcomes at 1-year.


Subject(s)
Cervical Vertebrae/surgery , Lordosis/classification , Postoperative Complications/etiology , Severity of Illness Index , Spinal Cord Diseases/etiology , Adult , Aged , Cervical Vertebrae/diagnostic imaging , Humans , Lordosis/diagnostic imaging , Lordosis/surgery , Middle Aged , Minimal Clinically Important Difference , Postoperative Complications/epidemiology , Radiography/methods , Radiography/standards , Spinal Cord Diseases/epidemiology
9.
Am J Emerg Med ; 49: 166-171, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34126562

ABSTRACT

OBJECTIVES: Children are often transferred to a Pediatric Emergency Department (PED) for definitive care after completion of diagnostic imaging. There is a paucity of data on the concordance rates of interpretation of imaging studies between referral and PED. Our objective is to describe the rates and clinical impact of discordant interpretation of X-rays and CT in children transferred to a PED. METHODS: This was a retrospective cohort study of patients over a 12-month period from 12/1/2017-11/30/2018 with X-ray (XR) and CT performed prior to transfer to our PED. We compared referral radiology interpretations to those of pediatric radiologists to determine concordance. Encounters with discordant imaging interpretations were further evaluated for clinical impact (none, minor or major) based on need for additional laboratory workup, consultation, and changes in management and disposition. RESULTS: We analyzed 899 patient encounters. There were high rates of concordance in both XR and CT interpretation (668/743; 89.9%, 95% CI 0.87-0.91 and 205/235; 87.2%, 95% CI 0.82-0.91, respectively). XR discordance resulted in minor clinical impact in 34 patients (45%, 95% CI 0.35-0.57) and a major clinical impact in 28 patients (37%, 95% CI 0.27-0.49). CT discordance resulted in minor clinical impact in 10 patients (33%, 95% CI 0.19-0.51) of patients and major clinical impact in 15 patients (50%, 95% CI 0.33-0.67). The most common discordances with major clinical impact were related to pneumonia on XR chest and appendicitis or inflammatory bowel disease on CT abdomen. CONCLUSIONS: In patients transferred to the PED, concordance of XR and CT interpretations was high. A majority of discordant interpretations led to clinical impact meaningful to the patient and emergency medicine (EM) physician. Referring EM physicians might consider the benefit of pediatric radiology consultation upon transfer, especially for imaging diagnoses related to pneumonia, appendicitis, or inflammatory bowel disease.


Subject(s)
Radiography/standards , Tomography, X-Ray Computed/standards , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Humans , Male , Patient Transfer/methods , Pediatric Emergency Medicine/methods , Radiography/methods , Retrospective Studies , Tomography, X-Ray Computed/methods
10.
Chiropr Man Therap ; 29(1): 19, 2021 05 26.
Article in English | MEDLINE | ID: mdl-34039379

ABSTRACT

BACKGROUND: The Commission of the European Communities (CEC) has published: European Guidelines on Quality Criteria for Diagnostic Radiographic Images. These guidelines are considered a gold standard, recommended for use in quality assurance protocols. The objectives of this study: 1) Propose a graded classification format for Danish chiropractic clinics according to the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. 2) Propose a reporting principle for quality of radiographic images. 3) Document variation in radiation exposure among clinics. METHODS: This is a cross-sectional study of image quality based on random sampling from 148 chiropractic clinics. Clinics were included if using: 1) Digital radiography and 2) The chiropractic picture and archiving system (KirPACS) at the Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB) in Denmark. A sample of 296 lumbar spine series were randomly collected from KirPACS (January 2018). Two independent observers reviewed 50 lumbar spine series twice with a 4-week interval, testing intra- and inter-observer reproducibility. The same observers then reviewed the remaining 246 radiographic studies. All studies were evaluated using the CEC Quality Criteria. Patient radiation dose values were retrieved from KirPACS (First quarter of 2020). RESULTS: A reporting and classification principle of diagnostic image quality was used in 148 chiropractic clinics. Compliance with the 22 CEC Quality Criteria had proportions ranging from 0.72-0.96 for 18 criteria, while 4 criteria specifying detail and definition ranged between 0.20-0.66. The proposed rating system (A to E) revealed: 18 A clinics, 28 B clinics, 32 C clinics, 25 D clinics and 45 E clinics (A = highest quality; E = lowest quality). The patient radiation reference dose in Denmark is 7 mGy for the AP/PA lumbar spine. Very few clinics exceed the reference dose value, approximately 50% of clinics were below 5 mGy. CONCLUSION: A reporting principle is proposed for a graded classification format based on the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. The Quality Criteria are for the most part met satisfactorily in 148 Danish chiropractic clinics, but important image details are compromised, in most cases, because of low patient radiation doses. The results of a patient radiation dose survey enabled documentation of variation in radiation exposure among chiropractic clinics.


Subject(s)
Chiropractic , Guideline Adherence , Lumbar Vertebrae/diagnostic imaging , Radiography/standards , Cross-Sectional Studies , Denmark , Double-Blind Method , Humans
11.
Worldviews Evid Based Nurs ; 18(4): 311-313, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33991060

ABSTRACT

BACKGROUND: Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death. AIMS: To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU. METHODS: The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits). RESULTS: Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, "OK to use" order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site. LINKING ACTION TO EVIDENCE: Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.


Subject(s)
Clinical Competence/standards , Critical Care Nursing/standards , Evidence-Based Nursing/standards , Intubation, Gastrointestinal/standards , Intubation, Intratracheal/standards , Patient Safety/standards , Radiography/standards , Adult , Aged , Aged, 80 and over , Female , Humans , Longitudinal Studies , Male , Middle Aged , Practice Guidelines as Topic
12.
Acta Orthop Traumatol Turc ; 55(2): 127-133, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33847574

ABSTRACT

OBJECTIVE: This study aimed to determine the reliability levels of the radiographic union scale for tibial fractures (RUST) and the modified version of the system, mRUST, for femoral shaft fractures in pediatric and adult patients and to evaluate the value of the scores for total and each cortex in the decision making on fracture union. METHODS: A total of 15 orthopedic surgeons scored the radiographs of 24 pediatric and 24 adult patients with femoral shaft fractures that were obtained at 0, 4, 8, 12, and 16 postoperative weeks treated with elastic stable intramedullary nail in pediatric patients and locked intramedullary nail in adult patients using the RUST and mRUST scores. Intra-class correlation coefficient (ICC) was used in the evaluation of reliability of the RUST and mRUST scores. The Fleiss kappa (k) coefficient was used in the agreement between evaluators regarding union decision (united or non-united). The thresholds for RUST and mRUST for radiographic union decision were determined. Receiver operating curves were created to evaluate the contribution of total and individual cortical scores in the decision of united or non-united. RESULTS: Intra- and inter-rater reliabilities of mRUST (ICC: 0.92 and 0.86, respectively) were slightly higher than those of RUST (ICC: 0.81 and 0.77, respectively) with perfect intra- and inter-rater reliabilities for RUST (ICC: 0.92 and 0.90, respectively) and mRUST (ICC: 0.88 and 0.83, respectively) in pediatric patients and substantial intra- and inter-rater reliabilities in adult patients (ICC: 0.80 and 0.76, respectively, for mRUST, and 0.76 and 0.71, respectively, for RUST). At each time point, the mean mRUST and RUST scores were higher for pediatric fractures (p<0.001). The Fleiss k coefficient for union decision was perfect for pediatric fractures (0.88) and substantial for adult fractures (0.79). The total mRUST score had a higher predictive value of union than the total RUST score (area under the curve: 0.984 vs. 0.922 in adult fractures and 0.990 vs. 0.943 in pediatric fractures). A RUST score of ≥10 and mRUST score of ≥12 were excellent predictors of fracture union. CONCLUSION: Fracture union of simple two-part pediatric and adult femoral shaft fractures treated with intramedullary fixation can be reliably assessed using the RUST and mRUST scores. The diagnostic value of the mRUST score is more evident in adult fractures. LEVEL OF EVIDENCE: Level II, Diagnostic Study.


Subject(s)
Femoral Fractures , Fracture Fixation, Intramedullary , Radiography , Adult , Child , Female , Femoral Fractures/diagnostic imaging , Femoral Fractures/surgery , Fracture Fixation, Intramedullary/adverse effects , Fracture Fixation, Intramedullary/instrumentation , Fracture Fixation, Intramedullary/methods , Fracture Healing , Fractures, Ununited/diagnostic imaging , Humans , Male , Postoperative Period , Radiography/methods , Radiography/standards , Reproducibility of Results , Research Design
13.
Eur J Med Genet ; 64(4): 104185, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33662637

ABSTRACT

Musculoskeletal symptoms may be due to noninflammatory causes, including genetic disorders. We aimed to examine the final genetic diagnosis in patients who presented with musculoskeletal complaints to the rheumatology department. Patients who presented to the Department of Pediatric Rheumatology and were referred to the pediatric genetic department between January 2015 and May 2019 were evaluated retrospectively. A total of 60 patients, 19 boys (31.66%), with a mean age of 12.46 ± 1.41 years were included in the study. The total consanguinity rate was 25%. The most common (29.5%) cause of referral to the pediatric genetic department was the presence of skeletal anomalies (such as camptodactyly, clinodactyly, and short stature) with accompanying joint findings. Approximately one-third of the patients (n: 19) were diagnosed and followed up by the pediatric genetics department. The diagnoses of patients were as follows: camptodactyly, arthropathy, coxa vara, and pericarditis (CACP) syndrome (n: 3); trichorhinophalangeal syndrome (n: 1); progressive pseudorheumatoid dysplasia (n: 2); LIG4 syndrome (n: 1); H syndrome (n: 1); spondyloenchondrodysplasia (SPENCD) (n: 3); and nonspecific connective tissue disorders (n: 8). In the differential diagnosis of patients who are referred to the Department of Pediatric Rheumatology with complaints of the musculoskeletal system, genetic disorders should also be considered.


Subject(s)
Genetic Testing/standards , Limb Deformities, Congenital/genetics , Rheumatic Diseases/genetics , Adolescent , Child , Diagnosis, Differential , Female , Genetic Testing/methods , Humans , Limb Deformities, Congenital/diagnosis , Limb Deformities, Congenital/diagnostic imaging , Male , Radiography/standards , Rheumatic Diseases/diagnosis , Rheumatic Diseases/diagnostic imaging
14.
Acta Orthop Traumatol Turc ; 55(1): 62-66, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33650514

ABSTRACT

OBJECTIVE: This study aimed to compare 2 methods of ulnar variance (UV) measurement (the perpendicular method and the circular method) and to determine whether UV changed based on the demographic characteristics (sex and age). METHODS: UV was measured on bilateral wrist radiographs of 124 patients (62 men, 62 women; mean age=48.5 years; range=18-79 years) who had no history of trauma, congenital wrist anomaly, previous wrist surgery, and wrist osteoarthritis by a single radiologist with 4 years of experience. All measurements were made on standardized radiographic images using 2 methods: the perpendicular method and the circular method. All the patients were then divided into groups based on sex and age, and the study population was determined by selecting a similar number of patients for each sex and age group. RESULTS: The mean UV of the right and left wrists was measured as 0.33 (range=-4.3 to 5.7) mm by the perpendicular method and as 0.034 (range=-5 to 5.7) mm by the circular method. A significant difference was determined between the 2 measurement methods (p<0.001). There was a statistically significant difference between sex and UV values in the left wrist measurements by both methods (p<0.05). A significant correlation was found between the UV and age in both right and left side measurements, indicating a statistically significant difference between the methods (p<0.001). CONCLUSION: The results of our study demonstrated significant differences in the UV measurement between the 2 methods. Furthermore, UV measurement may change based on age and sex. These differences should be considered in the treatment planning of patients with wrist disorders. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Subject(s)
Body Weights and Measures , Radiography , Ulna/diagnostic imaging , Wrist Joint/diagnostic imaging , Age Factors , Analysis of Variance , Anthropometry , Biological Variation, Population , Body Weights and Measures/methods , Body Weights and Measures/statistics & numerical data , Demography , Female , Humans , Male , Middle Aged , Radiography/methods , Radiography/standards , Reference Values , Retrospective Studies , Sex Factors
16.
Sleep Breath ; 25(4): 2297-2305, 2021 12.
Article in English | MEDLINE | ID: mdl-33559004

ABSTRACT

PURPOSE: In 2-dimensional lateral cephalometric radiographs, patients with severe obstructive sleep apnea (OSA) exhibit a more crowded oropharynx in comparison with non-OSA. We tested the hypothesis that machine learning, an application of artificial intelligence (AI), could be used to detect patients with severe OSA based on 2-dimensional images. METHODS: A deep convolutional neural network was developed (n = 1258; 90%) and tested (n = 131; 10%) using data from 1389 (100%) lateral cephalometric radiographs obtained from individuals diagnosed with severe OSA (n = 867; apnea hypopnea index > 30 events/h sleep) or non-OSA (n = 522; apnea hypopnea index < 5 events/h sleep) at a single center for sleep disorders. Three kinds of data sets were prepared by changing the area of interest using a single image: the original image without any modification (full image), an image containing a facial profile, upper airway, and craniofacial soft/hard tissues (main region), and an image containing part of the occipital region (head only). A radiologist also performed a conventional manual cephalometric analysis of the full image for comparison. RESULTS: The sensitivity/specificity was 0.87/0.82 for full image, 0.88/0.75 for main region, 0.71/0.63 for head only, and 0.54/0.80 for the manual analysis. The area under the receiver-operating characteristic curve was the highest for main region 0.92, for full image 0.89, for head only 0.70, and for manual cephalometric analysis 0.75. CONCLUSIONS: A deep convolutional neural network identified individuals with severe OSA with high accuracy. Future research on this concept using AI and images can be further encouraged when discussing triage of OSA.


Subject(s)
Cephalometry , Deep Learning , Radiography , Sleep Apnea, Obstructive/diagnostic imaging , Adult , Cephalometry/methods , Cephalometry/standards , Female , Humans , Male , Middle Aged , Radiography/methods , Radiography/standards , Sensitivity and Specificity
17.
J Med Libr Assoc ; 109(1): 112-119, 2021 Jan 01.
Article in English | MEDLINE | ID: mdl-33424472

ABSTRACT

BACKGROUND: Despite a strong research presence in Lancashire Teaching Hospitals National Health Service (NHS) Foundation Trust (LTHTR), allied health professionals from the organization are underrepresented in developing and publicizing research that is inspired by day-to-day clinical practice and staff experiences. Two LTHTR departments, Library and Knowledge Services (LKS) and Research and Innovation (R&I), came together to enable a group of staff to develop the knowledge and skills that they needed to access information and create new "home grown" research. CASE PRESENTATION: A clinical librarian and an academic research nurse created a research engagement program in the diagnostic radiography department at LTHTR, which included the development, delivery, and evaluation of 6 workshops. Sixteen individuals took part in these workshops, and data were collected on library usage, self-efficacy in information literacy, and research output before and after their delivery. Library membership increased by 50% among diagnostic radiography staff, literature search requests from this department increased by 133%, and all participants who attended at least 1 workshop reported an increased Information Literacy Self Efficacy Scale (ILSES) score. An increase in research activity and outputs was also attributed to the program. CONCLUSIONS: This project has resulted in a set of freely available workshop plans and support resources that can be customized for other health care professionals and has won several awards for its innovative use of departmental collaboration. Through the evaluation of the program from workshop attendees and non-attenders, we have identified impacts, outputs, and barriers to engagement in order to continue to deliver this content to other departments and embed a home grown research culture at LTHTR.


Subject(s)
Health Literacy/standards , Information Storage and Retrieval/methods , Librarians/statistics & numerical data , Libraries, Medical/standards , Radiography/standards , Allied Health Personnel , Cooperative Behavior , Humans , Information Literacy , Organizational Case Studies , Program Evaluation , State Medicine , United Kingdom
19.
Ann Diagn Pathol ; 51: 151708, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33513547

ABSTRACT

BACKGROUND: The management of benign and borderline phyllodes tumors of the breast with a positive surgical margin is still controversial. Our aim in this study was to evaluate the impact of surgical margin status on the local recurrence rate of benign and borderline phyllodes tumors. METHODS: We reviewed 205 phyllodes tumors (191 benign, 14 borderline) that were surgically excised at our hospital between 2005 and 2019. Follow-up information extending to at least 6 months after surgery was retrieved from the clinical, radiology, and pathology records. RESULTS: The initial surgical margin was negative in 54 (26%) cases, close (≤ 1 mm) in 29 (14%) cases, and positive in 122 (60%) cases. Approximately half of the cases with a close margin and two-third of the cases with a positive margin underwent re-excision to obtain negative margins. Three (2.3%) local recurrences were observed among 131 cases with follow-up information, all three with benign phyllodes tumor. Of these three patients, one had a positive final margin, and two had negative final margins. There was no significant difference in the rate of local recurrence between PT with a positive surgical margin versus a close and negative margin. CONCLUSION: The study results suggest that close clinical and radiologic follow-up may provide a better course of management rather than re-excision when managing positive margins in benign and borderline phyllodes tumors.


Subject(s)
Breast Neoplasms/pathology , Neoplasm Recurrence, Local/epidemiology , Phyllodes Tumor/diagnosis , Phyllodes Tumor/surgery , Adolescent , Adult , Aged , Biopsy, Large-Core Needle/methods , Case-Control Studies , Female , Follow-Up Studies , Humans , Margins of Excision , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Phyllodes Tumor/pathology , Radiography/standards , Reoperation/statistics & numerical data , Retrospective Studies , Young Adult
20.
Arch Orthop Trauma Surg ; 141(1): 55-61, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32377844

ABSTRACT

INTRODUCTION: Long-leg radiographs are used to plan and supervise the correction of bone deformity in patients treated with the Taylor Spatial Frame (TSF). Often radiographs are performed with malpositioning of the limb leading to wrong alignment measurements. The aim of this retrospective study was to show the usefulness of a simple device which might enhance the reproducibility of limb rotation on long-leg radiographs. MATERIALS AND METHODS: We included 20 consecutive patients with TSF treatment and at least three long-leg radiographs (4.9 ± 1.3). Eight out of 20 patients received radiographs with the help of a rotation rod (device with two clamps and a carbon tube). It is placed at the most frontal tab of the reference ring while conducting the radiograph. By this means, limb rotation can be controlled. To show the usefulness of this device, two observers measured the relation of the distances between the middle of the reference ring to the medial and lateral fourth hole on the reference ring (TSF-RR). The standard deviation and range of the TSF-RR of all radiographs for each patient was calculated and compared between patients without and with the rotation rod. RESULTS: The standard deviations of TSF-RR in patients without the rotation rod was significantly higher compared to patients with rotation rod (observer 1: p = 0.0228, observer 2: p = 0.0038). Also, the range of the TSF-RR within one patient is significant higher (observer 1: p = 0.0279, observer 2: p = 0.0038) in patients without the rotation rod compared to patients with the rotation rod. CONCLUSIONS: The variability of rotation on radiographs was lower with the rotation rod. Therefore, more reproducible and better comparable radiographs can be conducted. Radiologic exposure might be reduced as repetition of wrongly positioned limbs on radiographs are less frequent.


Subject(s)
Lower Extremity/diagnostic imaging , Patient Positioning/methods , Radiography , Humans , Radiography/methods , Radiography/standards , Retrospective Studies , Rotation
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