Anterior superior iliac spine is not always reliable as a pelvic reference axis. -3D study of pelvic axis.

BACKGROUND: This study aims to evaluate the accuracy of the axis connecting both anterior superior iliac spines (ASIS axis) as the absolute pelvic axis. No study has ever verified the accuracy of ASIS axis particularly on the AP pelvic radiograph, which cannot be specified on it. METHODS: Sixty patients who underwent total knee arthroplasty and fifty patients with femoral neck fracture were recruited as subjects without hip deformities and their CT scan data were collected. We defined the line through both center of femoral heads as absolute reference axis of pelvis three-dimensionally. On the coronal plane, the errors between the femoral head axis and the axes through six pelvic landmarks in total, including ASIS were analyzed. On the axial plane, the errors of the lines through four landmarks were analyzed in the same way. Finally, on the coronal images, the mediolateral diameter of the obturator foramen and the mediolateral distance between the midline of the sacrum and the pelvic cavity were measured to evaluate bilateral symmetry of the pelvis. RESULTS: The errors tended to be smaller as the axes were closer to the femoral head axis (axes connecting bilateral superior aspects of the acetabulum and the teardrops) and the ASIS axis errors were moderate. The obturator foramen based on the ASIS axis was more asymmetrical than the femoral head axis. CONCLUSION: Adjusting the pelvic tilt and rotation, surgeons should not always rely on the ASIS and refer to appropriate, close to the hip joint references in each case.

A laser guide technique: a novel method for accurate acetabular cup alignment in total hip arthroplasty.

For accurate cup alignment without navigation in total hip arthroplasty (THA), we developed a "laser guide technique." The major purposes of this paper are to introduce the technique and compare its accuracy with a conventional manual technique. As a clinical outcome, the dislocation rate was reviewed. Our laser guide technique, which includes preoperative postural adjustment and intraoperative angular reference, has been detailed in the manuscript. 599 hips in 523 patients who underwent primary THA with piriformis-sparing posterolateral approach in April 2010-March 2016 were reviewed. Patients were divided into three groups: conventional group (135 hips), laser guide group (80 hips), and laser + radiographic alignment guide group (384 hips). Radiographic inclination (RI) and radiographic anteversion (RA) errors were evaluated. The dislocation rate was reviewed in 540 hips in 476 patients who were followed up > 2 years postoperatively. Absolute values of the RI/RA error in the three groups were 5.3° ± 4.0°/6.5° ± 4.5°, 4.0° ± 2.8°/4.9° ± 4.4°, and 3.3° ± 2.6°/3.6° ± 2.8°, respectively, indicating substantially enhanced accuracy with laser and radiographic alignment guide. The dislocation rates were 2.5% (3/119) and 0.2% (1/421) in the conventional and laser groups, respectively. Our novel laser guide technique considerably enhanced cup alignment accuracy, suggesting its potential applicability for THA in the lateral decubitus position.

Optimizing contrast-enhanced echocardiography by employing a sonographer driven protocol.

BACKGROUND: The use of enhancing agents in echocardiography has been shown to facilitate improved study quality. Despite the known benefits, its use remains limited by institutional policies. METHODS: We aimed to retrospectively evaluate if allowing sonographers to place a peripheral intravenous catheter and administer enhancing agent led to a decrease in time to complete outpatient transthoracic echocardiograms in comparison to using nursing personnel. Three separate protocols were employed. The 'nurse driven protocol' utilized nurses to place a peripheral intravenous catheter and inject enhancing agent. In a 'mixed protocol,' a nurse placed a peripheral intravenous catheter and the sonographer gave the enhancing agent. The 'sonographer driven protocol' involved the sonographer placing the peripheral intravenous catheter and delivering enhancing agent. RESULTS: A total of 232 echocardiograms were included for analysis. Patient characteristics across the three protocols were not statistically significant. The 'mixed protocol' had an average study time that was significantly less than the 'nurse driven protocol' (49.4 min ± 11.4 vs 54.6 min ± 12.9; p = 0.024). The 'sonographer driven protocol' also showed a significant reduction in study time (50.3 min ± 12.6) when compared to the 'nurse driven protocol' (p = 0.017). The additional task for the sonographer to place the peripheral intravenous catheter did not significantly increase the time to complete the study. CONCLUSION: Allowing sonographers to administer enhancing agent reduced individual echocardiogram study times by approximately 5 min, supporting that a 'sonographer driven protocol' is more efficient with potential downstream economic benefits.

Reporting the Presence of Coronary Artery Calcium in the Final Impression of Non-gated CT Chest Scans Increases the Appropriate Utilization of Statins.

Background Coronary artery calcium (CAC) scoring based on gated non-contrast cardiac computed tomography (CT) is a validated risk marker of major adverse cardiovascular events (MACE). Reporting of CAC on non-gated CT chest (NGCT) scans and the impact on medical therapy is not well studied. Methods A retrospective cohort of 5,043 NGCT scans was reviewed for the presence of CAC. The radiology report was reviewed to determine whether CAC was mentioned in either the body of the report or the final impression. Electronic medical records (EMR) were abstracted for baseline demographics, cardiovascular (CV) risk factors, lipid-lowering agents, and aspirin (ASA) prior to and after NGCT. Results CAC was present in 63.0% of NGCT scans. Of these scans, CAC was mentioned in the body of the report in 81.6% of studies. Conversely, CAC was mentioned in the final impressions in only 15.1% of these scans. Amongst patients with CAC, initiation of a statin in treatment-naive patients was more common when CAC was mentioned in the final impression versus the body only (12.3% vs. 4.9%, p=0.001) despite the fact that baseline utilization of statins in this cohort was higher (71.1% vs. 64.1%, p=0.005). Initiation of a statin in treatment-naive patients had a trend towards significance when CAC was mentioned in the body of the report versus not reported (4.9% vs. 2.62%, p=0.142). Reporting of CAC in the final impression significantly increased the initiation of ASA in treatment-naive patients (9.52% vs. 4.33%, p=0.033). Reporting of CAC in either the final impression or the body of the report did not affect the initiation of non-statin lipid-lowering therapies in patients with CAC. Conclusion The inclusion of CAC in the final impression of NGCT radiology reports positively impacts the appropriate initiation of statin and aspirin therapy in treatment-naive patients. Universal adherence to a standardized reporting system for the presence of CAC on NGCT should be considered to improve the initiation of guideline-directed medical therapy.

Incidence and Implication of Coronary Artery Calcium on Non-gated Chest Computed Tomography Scans: A Large Observational Cohort.

Introduction  Coronary artery calcification (CAC) scoring is typically performed utilizing non-contrast, electrocardiogram- (ECG) gated CT and offers an estimation of cardiovascular (CV) prognosis and risk stratification beyond previously established cardiac risk factors. Coronary calcification can also be assessed during non-gated chest CT, which is significant given the recent recommendations for lung cancer screening by low-dose CT. Methods We retrospectively reviewed 4,953 non-contrast chest CT scans in a single, closed referral tertiary military treatment facility over an 18-month period. Baseline CV outcomes to include myocardial infarction (MI), cerebral vascular accidents (CVA), revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), death, or a composite of all major adverse cardiac events (MACE), and baseline CV risk factors were abstracted from an electronic medical record (EMR) review. Results CAC was seen in 3,119 (63%) patients while 1,834 (27%) were without CAC. All traditional CV risk factors were more commonly observed in patients with CAC. Unadjusted odds of composite MACE, death, MI, coronary revascularization, and CVA between presence and absence of CAC were as follows: 3.55 [95% confidence interval (CI): 2.60-4.86, p: <0.0001]; 2.98 (95% CI: 2.02-4.40, p: <0.0001); 24.42 (95% CI: 3.36-177.6, p: <0.0001); 5.64 (95% CI: 2.58-12.32, p: <0.0001); and 2.32 (95% CI: 1.19-4.50, p: 0.0104), respectively. However, after adjusting for baseline risk factors, CAC on non-gated CT was associated only with an increased observed rate of MI (aOR: 38.1, 95% CI: 4.57-318.2, p: <0.0001) and revascularization (aOR: 5.58, 95% CI: 2.22-14.0, p; 0.0003). Conclusions Findings of CAC on non-gated chest CT may help to recognize patients who are at increased risk of MI and revascularization. Given the expected increase in chest CT utilization among former smokers for lung cancer screening, observed CAC should be reported to ordering providers in order to identify patients at increased risk of these important outcomes.