The Accuracy of Digital Radiography for Diagnosis of Fishbone Foreign Bodies in the Throat

Abstract Introduction Some patients with a fishbone as a foreign body of difficult diagnosis may require further investigations. Generally, radiography is used as the first choice for finding the fishbone. Objective The objective of this study is to determine the accuracy of digital radiography for diagnosis of fishbone foreign body in the throat Methods This descriptive experimental study design has three phases. In the first phase, we assessed subject contrast and visibility of fishbone on a homogeneous background; as for the second phase, we evaluated the embedded fishbone in the fresh cadaver's throat. In the last phase, we studied the accuracy of radiography in diagnosing the fishbone foreign body at any site of the cadaver's throat. Results The subject contrast of 15 fishbones ranged from 0.94 to 0.99. All types of fishbone were obvious in the first phase, whereas, in the second phase, visibility of fishbone was varied. The subject contrast and diameter of fishbone did not show statistically significant correlation with visibility (p = 0.09 and p = 0.24, respectively). In the third phase, embedded fishbone in the base of tongue was detected with the highest accuracy (sensitivity of 1.00 (95%CI: 0.44-1.00) and specificity of 0.92 (95%CI: 0.65-0.99)); whereas, the tonsil was of difficult interpretation with poorest diagnostic value (sensitivity of 0.00 (95%CI: 0.00-0.56) and specificity of 1.00 (95%CI: 0.76-1.00)). Conclusion The digital radiography provides the highest accuracy and benefit to the diagnosis of a fishbone foreign body at the base of the tongue; whereas, the tonsil was of difficult interpretation.

The Accuracy of Digital Radiography for Diagnosis of Fishbone Foreign Bodies in the Throat.

Introduction Some patients with a fishbone as a foreign body of difficult diagnosis may require further investigations. Generally, radiography is used as the first choice for finding the fishbone. Objective The objective of this study is to determine the accuracy of digital radiography for diagnosis of fishbone foreign body in the throat Methods This descriptive experimental study design has three phases. In the first phase, we assessed subject contrast and visibility of fishbone on a homogeneous background; as for the second phase, we evaluated the embedded fishbone in the fresh cadaver's throat. In the last phase, we studied the accuracy of radiography in diagnosing the fishbone foreign body at any site of the cadaver's throat. Results The subject contrast of 15 fishbones ranged from 0.94 to 0.99. All types of fishbone were obvious in the first phase, whereas, in the second phase, visibility of fishbone was varied. The subject contrast and diameter of fishbone did not show statistically significant correlation with visibility ( p = 0.09 and p = 0.24, respectively). In the third phase, embedded fishbone in the base of tongue was detected with the highest accuracy (sensitivity of 1.00 (95%CI: 0.44-1.00) and specificity of 0.92 (95%CI: 0.65-0.99)); whereas, the tonsil was of difficult interpretation with poorest diagnostic value (sensitivity of 0.00 (95%CI: 0.00-0.56) and specificity of 1.00 (95%CI: 0.76-1.00)). Conclusion The digital radiography provides the highest accuracy and benefit to the diagnosis of a fishbone foreign body at the base of the tongue; whereas, the tonsil was of difficult interpretation.

Configuration of the Ethmoidal Roof: A Radiologic Anatomical Study

Background: Currently endoscopic sinus surgery is the standard operation for rhinosinusitis and nasal polyps, including tumors near the anterior skull base. During the surgery, the iatrogenic penetration into the anterior skull base may be at risk. Therefore, information of the anterior skull base configuration is useful for the sinus surgeon. Objective: To determine the patterns and their prevalence of slopes of the ethmoidal roof assessed from the Computed Tomography (CTs) of paranasal sinuses. Material and Method: A descriptive study was conducted at Srinagarind Hospital, Faculty of Medicine, Thailand. CTs of paranasal sinuses from 150 patients aged 18 years and above who had attended at Srinagarind hospital between January 1, 2007 and December 31, 2011 were retrieved and reviewed. The slope patterns of the ethmoidal roof were determined by visual assessment of the scans, measuring the height between the ethmoidal roof and floor of nasal cavities in three sagittal planes: medio-sagittal, latero-sagittal, and mid-sagittal. CTs were performed by a Philips 128 slice scanner. Results: The downslope anteriorly and upslope posteriorly of the ethmoidal roof was found to be commonest in medio-sagittal and mid-sagittal planes. Its prevalence in medio-sagittal and mid-sagittal planes was 80.3% (95% CI 75.5-84.4) and 52% (95% CI 46.4-57.6). The second common pattern in medio-sagittal and mid-sagittal planes was a downslope pattern with the prevalence of 13% (95% CI 9.7-17.3) and 39.3% (95% CI 34-44). The downslope pattern was found to be the most prevalent for the latero-sagittal plane, accounting for 50.7% (95% CI 45.0-56.3), followed by downslope anteriorly and upslope posteriorly of 40% (95% CI 34.6-45.6). Conclusion: This is the first study to describe the patterns of slopes of the ethmoidal roof (anterior skull base) which demonstrates that there are different patterns depending on the plane of sagittal view. Therefore, the sagittal view of the CT paranasal sinus in each plane should be interpreted before performing the operation to avoid iatrogenic intracranial complications.