The correlation between lumbar interlaminar space size on plain radiograph and spinal stenosis.

PURPOSE: Investigating the correlation between the interlaminar space size on plain radiograph and lumbar spinal stenosis (LSS). METHODS: 100 Patients with LSS and 100 normal participants without LSS were included in this study. Lumbar interlaminar parameters were measured on plain radiographs. Spinal canal parameters were measure on CT and MRI. These image parameters were compared between LSS and control group. The linear correlation among interlaminar parameters, spinal canal parameters and Oswestry Disability Index (ODI) were analyzed. The cut-off values of interlaminar parameters for diagnosing L3/4 and L4/5 symptomatic LSS were analyzed. RESULTS: Excepting for L1/2 interlaminar width, all interlaminar and spinal canal related parameters in LSS group were significantly smaller than those in control group. Excepting for L1/2 interlaminar width and L5/S1 interlaminar height, all interlaminar parameters had significantly positive linear correlation with spinal canal parameters accordingly in each lumbar level. For diagnosis of symptomatic LSS, The cut off values of L4/5 interlaminar width, height and area were 18.46 mm, 11.37 mm and 134.05 mm2 while 15.78 mm, 13.59 mm and 157.98 mm2 in L3/4. Both spinal canal size and interlaminar size had no linear correlation with ODI in cases of L4/5 LSS. CONCLUSIONS: Lumbar interlaminar space size on plain radiograph has positive linear correlation with developmental and degenerative LSS, excepting for L1/2 interlaminar width and L5/S1 interlaminar height. Lumbar plain radiograph can be a feasible way for predicting and helping to diagnose LSS through evaluating the interlaminar space size. LEVEL OF EVIDENCE: III.

Deep learning-based landmark recognition and angle measurement of full-leg plain radiographs can be adopted to assess lower extremity alignment.

PURPOSE: Evaluating lower extremity alignment using full-leg plain radiographs is an essential step in diagnosis and treatment of patients with knee osteoarthritis. The study objective was to present a deep learning-based anatomical landmark recognition and angle measurement model, using full-leg radiographs, and validate its performance. METHODS: A total of 11,212 full-leg plain radiographs were used to create the model. To train the data, 15 anatomical landmarks were marked by two orthopaedic surgeons. Mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and hip-knee-ankle angle (HKAA) were then measured. For inter-observer reliability, the inter-observer intraclass correlation coefficient (ICC) was evaluated by comparing measurements from the model, surgeons, and students, to ground truth measurements annotated by an orthopaedic specialist with 14 years of experience. To evaluate test-retest reliability, all measurements were made twice by each measurer. Intra-observer ICCs were then derived. Performance evaluation metrics used in previous studies were also derived for direct comparison of the model's performance. RESULTS: Inter-observer ICCs for all angles of the model were 0.98 or higher (p < 0.001). Intra-observer ICCs for all angles were 1.00, which was higher than that of the orthopaedic specialist (0.97-1.00). Measurements made by the model showed no significant systemic variation. Except for JLCA, angles were precisely measured with absolute error averages under 0.52 degrees and proportion of outliers under 4.26%. CONCLUSIONS: The deep learning model is capable of evaluating lower extremity alignment with performance as accurate as an orthopaedic specialist with 14 years of experience. LEVEL OF EVIDENCE: III, retrospective cohort study.

An AI-Based Image Quality Control Framework for Knee Radiographs.

Image quality control (QC) is crucial for the accurate diagnosis of knee diseases using radiographs. However, the manual QC process is subjective, labor intensive, and time-consuming. In this study, we aimed to develop an artificial intelligence (AI) model to automate the QC procedure typically performed by clinicians. We proposed an AI-based fully automatic QC model for knee radiographs using high-resolution net (HR-Net) to identify predefined key points in images. We then performed geometric calculations to transform the identified key points into three QC criteria, namely, anteroposterior (AP)/lateral (LAT) overlap ratios and LAT flexion angle. The proposed model was trained and validated using 2212 knee plain radiographs from 1208 patients and an additional 1572 knee radiographs from 753 patients collected from six external centers for further external validation. For the internal validation cohort, the proposed AI model and clinicians showed high intraclass consistency coefficients (ICCs) for AP/LAT fibular head overlap and LAT knee flexion angle of 0.952, 0.895, and 0.993, respectively. For the external validation cohort, the ICCs were also high, with values of 0.934, 0.856, and 0.991, respectively. There were no significant differences between the AI model and clinicians in any of the three QC criteria, and the AI model required significantly less measurement time than clinicians. The experimental results demonstrated that the AI model performed comparably to clinicians and required less time. Therefore, the proposed AI-based model has great potential as a convenient tool for clinical practice by automating the QC procedure for knee radiographs.

Postoperative Angular Changes According to Weightbearing in Patients With Moderate to Severe Hallux Valgus.

Hallux valgus is a progressive angular deformity of the big toe, the degree of which is aggravated in weightbearing stance. Hallux valgus and intermetatarsal angles on postoperative weightbearing images are usually larger than those of intraoperative fluoroscopic and immediate postoperative non-weightbearing images. Here, we hypothesized that various angular parameters of hallux valgus would increase postoperatively with weightbearing. A total of 66 feet (58 patients) of moderate to severe hallux valgus were reviewed on consecutive plain foot anteroposterior radiographs. The changes of hallux valgus, intermetatarsal, hallux valgus interphalangeal, and distal metatarsal articular angles were compared. Hallux valgus and intermetatarsal angles were significantly increased with weightbearing postoperatively (p < .001). Hallux valgus interphalangeal and distal metatarsal articular angles did not show significant changes with weightbearing (p > .5). Hallux valgus and intermetatarsal angles were increased with weightbearing after hallux valgus surgery. Mean angular changes were 5.3 and 2.7 degrees, respectively. These values should be considered in the preoperative planning and intraoperative correction processes.

Radiographic cervical spine degenerative findings: a study on a large population from age 18 to 97 years.

PURPOSE: The aims of this study were (1) to determine the prevalence of radiographic cervical disc degeneration in a large population of patients aged from 18 to 97 years; (2) to investigate individually the prevalence and distribution of height loss, osteophyte formation, endplate sclerosis and spondylolisthesis; and (3) to describe the patterns of cervical disc degeneration. METHODS: A retrospective study was performed. Standard lateral cervical spine radiographs in standing, neutral position of 1581 consecutive patients (723 males, 858 females) with an average age of 41.2 ± 18.2 years were evaluated. Cervical disc degeneration was graded from C2/C3 to C6/C7 based on a validated quantitative grading system. The prevalence and distribution of radiographic findings were evaluated and associations with age were investigated. RESULTS: 53.9% of individuals had radiographic disc degeneration and the most affected level was C5/C6. The presence and severity of disc degeneration were found to be significantly associated with age both in male and female subjects. The most frequent and severe occurrences of height loss, osteophyte formation, and endplate sclerosis were at C5/C6, whereas spondylolisthesis was most observed at C4/C5. Age was significantly correlated with radiographic degenerative findings. Contiguous levels degeneration pattern was more likely found than skipped level degeneration. The number of degenerated levels was also associated with age. CONCLUSIONS: The presence and severity of radiographic disc degeneration increased with aging in the cervical spine. Older age was associated with greater number of degenerated disc levels. Furthermore, the correlations between age and the degree of degenerative findings were stronger at C5/C6 and C6/C7 than at other cervical spinal levels.

Evaluation of Judet view radiographs accuracy in classification of acetabular fractures compared with three-dimensional computerized tomographic scan: a retrospective study.

BACKGROUND: In the current diagnostic procedure, generally, both plain radiographs and 3D-CT scans are used for the diagnosis of acetabular fractures. There is no consensus regarding the value of a three-dimensional computerized tomographic (3D-CT) scan alone in the classification of acetabular fractures. In this study, we compared the accuracy of 3D-CT scan and plain radiography through the evaluation of their agreement with the intraoperative surgeon's classification. METHOD: In a retrospective study, patients who were referred to our center with an acetabular fracture and underwent surgical treatment were included. The classification of acetabular fractures was performed once using Judet view plain radiographs and once using a 3D-CT scan by the corresponding one Experienced musculoskeletal radiologist one independent trauma fellowship-trained orthopaedic who routinely treat acetabular fractures and based on Letournel and Judet classification (17 and 23 years of experience respectively). Cohen's kappa value was used for the assessment agreement between the two imaging modalities, as well as between the imaging modalities and intraoperative classification. RESULTS: Medical files of 152 patients with acetabular fracture were retrospectively reviewed. A kappa value of 0.236 was obtained as the agreement level between radiographs and intraoperative findings (p < 0.001). A kappa value of 0.943 was obtained as the agreement level between 3D-CT and intraoperative classification (p < 0.001). An agreement level of 0.264 was found between the Judet radiographs and 3D-CT scans (p < 0.001). CONCLUSIONS: 3D-CT scans are reliable enough in the classification of acetabular fractures, and plain radiographs could be omitted to avoid radiation exposure as well as to reduce the cost for patients who sustain acetabular fractures.

Lumbar plain radiograph is not reliable to identify lumbosacral transitional vertebra types according to Castellvi classification principle.

BACKGROUND: The anteroposterior view of the lumbar plain radiograph (AP-LPR) was chosen as the original and first radiographic tool to determine and classify lumbosacral transitional vertebra with morphological abnormality (MA-LSTV) according to the Castellvi classification. However, recent studies found that AP-LPR might not be sufficient to detect or classify MA-LSTV correctly. The present study aims to verify the reliability of AP-LPR on detecting and classifying MA-LSTV types, taking coronal reconstructed CT images (CT-CRIs) as the gold criteria. METHODS: Patients with suspected MA-LSTVs determined by AP-LPR were initially enrolled. Among them, those who received CT-CRIs were formally enrolled to verify the sensitivity of AP-LPR on detecting and classifying MA-LSTV types according to the Castellvi classification principle. RESULTS: A total of 298 cases were initially enrolled as suspected MA-LSTV, among which 91 cases who received CT-CRIs were enrolled into the final study group. All suspected MA-LSTVs were verified to be real MA-LSTVs by CT-CRIs. However, 35.2% of the suspected MA-LSTV types judged by AP-LPR were not consistent with the final types judged by CT-CRIs. Two suspected type IIIa and 20 suspected type IIIb MA-LSTVs were verified to be true, while 9 of 39 suspected type IIa, 9 and 3 of 17 suspected type IIb, and 11 of 13 suspected type IV MA-LSTVs were verified to truly be type IIIa, IIIb, IV and IIIb MA-LSTVs by CT-CRIs, respectively. Incomplete joint-like structure (JLS) or bony union structure (BUS) and remnants of sclerotic band (RSB) between the transverse process (TP) and sacrum were considered to be the main reasons for misclassification. CONCLUSION: Although AP-LPR could correctly detect MA-LSTV, it could not give accurate type classification. CT-CRIs could provide detailed information between the TP and sacrum area and could be taken as the gold standard to detect and classify MA-LSTV.

Correct Assessment of Acetabular Component Orientation in Total Hip Arthroplasty From Plane Radiographs.

BACKGROUND: Correct positioning of the cup is an important factor in total hip arthroplasty. Assessing its position from a plain anteroposterior pelvic radiograph is known to be hampered by systemic errors. This study focuses on developing a correction method to adjust for these potential sources of error and to eliminate them based on a 3D geometric analysis. METHODS: Computed tomography scans of 113 (66 male, 47 female) pelvices were reconstructed and virtually projected onto a plain radiograph with varying rotational and translational positions. Thus cup inclination and anteversion as measured on a 2D-radiograph and in the 3D environment were correlated. Projected offset of the symphysis from the mid-sacrum served as a mean to measure pelvic right/left-rotation. Pelvic tilt was determined from the projected height of the contour of the small pelvis. Correction formulas were verified by projecting a gimbal-mounted artificial pelvis with a cup implanted in a known position. RESULTS: We found gender-specific formulas that correct for malrotated and off-centered radiographs. Applying these formulas cup inclination was assessed as close as 1.3° (±1.90°) to the true 3D value and cup anteversion as close as 1° (±1.91°) although deviations between directly measured plain values and corrected values rose up to 18°. CONCLUSION: Inherent effects of central projection and malrotations due to pelvic tilt, pelvic rotation, and noncentered radiographs are corrected. Evaluation of radiographic inclination and anteversion of acetabular cups from plain 2D-radiographs show improved precision. Real values are approached better than 1.3° when applying our correction formulas.

Can standard anterior Smith-Robinson supramanubrial approach be utilized for approach down to T2 or T3?

PURPOSE: The aim of this study was to determine a plain radiographic criterion for determining the feasibility of using the standard anterior Smith-Robinson supramanubrial approach for anterior surgery down to T2 or T3. METHODS: The surgical database (2002-2014) was searched to identify patients with anterior cervical surgery to T2 or T3. A method to determine whether a standard anterior Smith-Robinson approach can be used to operate on the upper thoracic levels was evaluated. The surgeon chose the surgical approach preoperatively using a lateral radiograph by determining if a line from the intended skin incision to the lower instrumented level (LIV) passed above the top of the manubrium. If so, a standard Smith-Robinson approach was selected. Another spine surgeon then analyzed all patients who had anterior thoracic fusion to T2 or below. The lateral radiographs were retrospectively reviewed. RESULTS: A total of 44 patients who underwent anterior surgery down to T2 or T3 vertebrae were identified. T2 was the LIV in 39 patients. T3 was the LIV in five patients. No surgery was abandoned or converted to a difference approach after making the standard Smith-Robinson approach. To increase visualization, T1 corpectomy was necessary in 4 of 39 patients when T2 was the LIV. T2 corpectomy was necessary in 2 of 5 patients when T3 was the LIV. CONCLUSION: If a line from the intended skin incision to the LIV passes over the top of the manubrium, a standard Smith-Robinson approach without sternotomy can be successfully used.

The radiologic assessment of posterior ligamentous complex injury in patients with thoracolumbar fracture.

PURPOSES: To discuss whether radiologic parameters are closely related to posterior ligamentous complex (PLC) injury identified by magnetic resonance imaging (MRI). METHODS: One hundred and five thoracolumbar fracture (T11-L2) patients were retrospectively analyzed in the study. The patients were divided into different groups by the status of the PLC on MRI: intact, incompletely ruptured and ruptured. The radiographic parameters included the anterior edge-inferior endplate angle (AEIEA), the anterior edge displacement (AED), the Cobb angle (CA), the region angle (RA), the sagittal index (SI), local kyphosis (LK), the anterior/posterior vertebral height ratio (A/P ratio), the anterior vertebral height ratio (AVH ratio), and bony fragment in front of the fractured vertebra (BFOFV). T test, Pearson's Chi-square and multivariate logistic regression were calculated for the variables. RESULTS: Supraspinous ligament (SSL) rupture versus intact was not only associated with the occurrence of AEIEA <70°, LK >25° and BFOFV, but also with increased AED (9.89 ± 3.12 mm and 9.34 ± 3.36 mm, P = 0.034), RA (9.52 ± 3.93° versus 7.91 ± 3.99°, P = 0.042), and LK (23.98 ± 5.88° versus 15.55 ± 5.28°, P = 0.021). The indications for interspinous ligament (ISL) injury included AEIEA <75°, AEIEA <70° (P = 0.004 and P < 0.001, respectively), increased AED (P = 0.010), LK >25° (P = 0.024), AVH (P < 0.001), and BFOFV (P < 0.001). Multivariate logistic regression analysis revealed that AEIEA <70° and BFOFV were high risk factors for SSL rupture [standard partial regression coefficients (betas) were 0.439 and 0.408, P = 0.003 and 0.001, respectively] and ISL rupture (betas were 0.548 and 0.494, P = 0.028 and 0.001, respectively). Increased AED and LK >25° were also related to either ISL rupture (P = 0.035 and 0.001, respectively) or SSL rupture (P = 0.014 and 0.008, respectively). CONCLUSION: Our data may prove useful in a preliminary assessment of the PLC integrity based on plain radiographic imaging. We show that radiologic indications, such as AEIEA <70°, BFOFV, LK >25°, and increased AED, are correlated with ISL or SSL rupture, while RA, CA, SI, A/P ratio, and AVH ratio are not.

Laterality of radiographic osteoarthritis of the knee.

There are few reports of the laterality in radiological knee osteoarthritis (ROA). This study aimed to evaluate laterality in terms of the minimum joint space width (mJSW) and osteophyte areas (OFs) in a cross-sectorial general population screen and elucidate the association between laterality and risk of osteoarthritis. We enrolled 330 participants (mean age 64.6 years) and examined the presence of ROA (Kellgren-Lawrence grade ≧ 2) laterality in terms of the mJSW and OF on the medial tibia using auto-measuring software. Moreover, we examined the association between laterality and leg dominance. The right and left medial mJSWs were 4.02 ± 0.98 mm and 4.05 ± 1.01 mm, respectively, showing no laterality; the laterals were also similar. The participants who had osteophytes ≥1 mm2 in the right, left, and bilateral knees were 15, 37, and 57 respectively, with osteophytes being significantly more common in the left knee. The OF was significantly larger in the left knee. Conversely, the medial and lateral mJSWs and OF did not differ according to leg dominance. The prevalence of ROA was higher and the OF was more pronounced in the left knee. However, the mJSW showed no laterality. Additionally, the mJSW and OF showed no differences according to leg dominance.

Absence of a relationship between joint space narrowing and osteophyte formation in early knee osteoarthritis among Japanese community-dwelling elderly individuals: A cross-sectional study.

OBJECTIVES: Joint space narrowing and osteophyte formation, radiographic features of knee osteoarthritis (OA), are not necessarily synchronous processes. We evaluated the relationship between medial minimum joint space width (mJSW) and osteophyte formation. METHODS: We conducted a retrospective study of 1050 individuals (424 males; 626 females; mean age 64.9 years) who underwent knee radiography as part of a health screening program, between 2011 and 2013. mJSW and tibial osteophyte area (OF) were quantified using automated software. The mJSW range was subdivided into tertiles, and OF, mJSW, and quality of life (QOL) were compared among them. Correlation between OF and mJSW was evaluated. RESULTS: In females, OF was largest and correlated with mJSW only in the lowest tertile group. Patients in the lowest mJSW tertile group had a lower QOL and higher pain than those in the other two groups. Based on our generalized additive models and a receiver operating characteristic curve analysis, an mJSW cutoff point of 3.5 mm was apparent in females, with no significant cutoff identified in males. CONCLUSIONS: OF correlates with mJSW below a cutoff value of about 3.5 mm in females. OA symptoms, namely physical function impairment and pain, increases significantly as mJSW decreases below the cutoff. .

Intervertebral bridging ossifications increase the risk of intravertebral cleft formation following a vertebral compression fracture.

PURPOSE: To determine whether the presence of intervertebral bridging ossifications is associated with intravertebral cleft (IVC) formation following a vertebral compression fracture (VCF). METHODS: Patients with a VCF who received conservative treatment for a minimum of 3 months were recruited over a 3-year period. Baseline radiographs obtained within a month of onset were compared between 50 patients who developed an IVC at 3-month follow-up (IVC group) and 100 patients without an IVC (control group). Intervertebral bridging ossification was defined as complete bridging of the intervertebral space by ossification. The presence of bridging ossification was assessed at each intervertebral level from T9/10 to L5/S. In addition to the absolute levels of bridging ossifications, the level relative to a fresh VCF was recorded. RESULT: The incidence of bridging ossification at levels T9/10 and T10/11 was significantly higher in the IVC group than in the control group. IVC group patients showed a significantly higher incidence of bridging ossification at the second proximal intervertebral segment than those in the control group. IVC group patients also had a significantly greater sagittal wedge angle and a greater local kyphosis angle than control group patients. CONCLUSION: A fresh VCF with bridging ossification at the second proximal intervertebral level is associated with increased risk of IVC formation. Careful observation and strict conservative treatment are recommended in such cases.

A new method to diagnose discoid lateral menisci on radiographs.

PURPOSE: The aim of this study was to prove that it is feasible to diagnose discoid lateral meniscus in radiographs. Plain radiographic findings of discoid lateral menisci with matched controls were analysed and compared in a quantitative method. METHODS: Sixty consecutive patients (60 knees) who were diagnosed with discoid lateral meniscus (discoid group) by magnetic resonance imaging (MRI) were included. Another 60 age- and sex-matched controls with normal medial and lateral menisci on the basis of MRI findings were included as the control group. Each plain radiograph was evaluated from the anteroposterior view for the following variables: height of the fibular head (HFH), lateral joint space distance (LJSD), height of the lateral tibial spine (HLTS), obliquity of the lateral tibial plateau, obliquity of the lateral femoral condyle, distance from the lateral tibial spine to the lateral femoral condyle, height of the medial tibial spine, chordal distance of the femoral condyle (CDLF, CDMF), the HFH/LJSD, LJSD/HLTS and the CDLF/CDMF. RESULTS: A significant difference was found in the HFH, LJSD, HLTS, DLC, CDLF, HFH/LJSD and LJSD/HLTS between the two groups. The cut-off values of the HFH, LJSD, HLTS, DLC, CDLF, HFH/LJSD and LJSD/HLTS were 12.9 mm, 6.6 mm, 7.8 mm, 3.0 mm, 2.7 mm, 2.0 and 0.9, respectively. Among the cut-off values in diagnosing discoid lateral meniscus, the sensitivity, specificity and ROC curve area of LJSD/HLTS were as high as 73.6 %, 83.0 % and 0.8, respectively. The corresponding values of the HFH/LJSD were as high as 66.0 %, 86.8 % and 0.8. For the first two indicators, the results of the HFH/LJSD and LJSD/HLTS were higher than that of most other parameters. At the same time, the ROC curve area of the HFH/LJSD and LJSD/HLTS ranked highest among all the results. CONCLUSION: There were significant differences in the HFH, LJSD, HLTS, DLC, CDLF, HFH/LJSD and LJSD/HLTS, especially the HFH/LJSD and the LJSD/HLTS, between plain radiographic findings of discoid lateral meniscus patients and normal controls. The results of the HFH/LJSD and the LJSD/HLTS showed a positive impact on the diagnosis of discoid lateral meniscus in this research. These findings enable radiographs to screen for discoid lateral meniscus. LEVEL OF EVIDENCE: II.

Validity of radiographic assessment of the knee joint space using automatic image analysis.

OBJECTIVES: The present study investigated whether there were differences between automatic and manual measurements of the minimum joint space width (mJSW) on knee radiographs. METHODS: Knee radiographs of 324 participants in a systematic health screening were analyzed using the following three methods: manual measurement of film-based radiographs (Manual), manual measurement of digitized radiographs (Digital), and automatic measurement of digitized radiographs (Auto). The mean mJSWs on the medial and lateral sides of the knees were determined using each method, and measurement reliability was evaluated using intra-class correlation coefficients. Measurement errors were compared between normal knees and knees with radiographic osteoarthritis. RESULTS: All three methods demonstrated good reliability, although the reliability was slightly lower with the Manual method than with the other methods. On the medial and lateral sides of the knees, the mJSWs were the largest in the Manual method and the smallest in the Auto method. The measurement errors of each method were significantly larger for normal knees than for radiographic osteoarthritis knees. CONCLUSIONS: The mJSW measurements are more accurate and reliable with the Auto method than with the Manual or Digital method, especially for normal knees. Therefore, the Auto method is ideal for the assessment of the knee joint space.

Comparison of plain x-rays and computed tomography for assessing distal radioulnar joint inclination.

PURPOSE: To compare the inclination of the distal radioulnar joint (DRUJ) on computed tomography (CT) and plain radiography (XR) in order to assess the effect of narrowing the range of inclination used in the original Tolat classification system to identify potentially problematic reverse oblique DRUJs. METHODS: Two independent investigators compared the angle of inclination and Tolat type on matched wrist XRs in the coronal plane and CTs of the same patients with normal DRUJs. The degree of agreement between XR and CT was determined. Inter- and intra-observer reliabilities were calculated. The prevalence of the 3 inclination types of the DRUJs using Tolat's definition was recorded. Their original quantitative definition of the parallel Tolat type 1 DRUJ included all DRUJs with a measured inclination of ±10°. We noted and compared the resultant changes in prevalence of the different DRUJ types after narrowing the inclination range to ±5° and ±3°. RESULTS: Highly significant correlation between CT and XR measurements were found for both observers. Despite this, the limits of agreement between CT and XR in determining the sigmoid notch inclination was -9° to 11° (±2° standard deviations from the mean difference). When measured from the CTs and using Tolat's original algorithm, the prevalence of Tolat type 1 DRUJ was 47% (N = 34), type 2 was 51% (N = 37), and type 3 was 1% (N = 1). These percentages changed to 7% (N = 5) for type 1, 78% (N = 56) for type 2, and 15% (N = 11) for type 3 when applying narrower ranges of inclination. CONCLUSIONS: Narrowing the range of sigmoid notch inclination that defines type 1 (parallel) DRUJs when using CT provided a more accurate representation of the morphological types. It revealed an increased number of potentially problematic type 3 DRUJs. However, the statistical limits of agreement between CT and XR suggested that high-resolution 3-dimensional imaging is required to apply the new algorithm. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

Gastrointestinal devices: common and uncommon foreign bodies.

Devices for the gastrointestinal tract are widely available and constantly advancing with less invasive techniques. They play a crucial role in diagnostic and therapeutic interventions and are commonly placed by interventional radiologists, gastroenterologists, and surgeons. These devices frequently appear in imaging studies, which verify their proper placement, identify any complications, or may be incidentally detected. Radiologists must be able to identify these devices at imaging and understand their intended purpose to assess their efficacy, detect complications such as incorrect positioning, and avoid misinterpreting them as abnormalities. Furthermore, many patients with these devices may require MRI, making assessing compatibility essential for safe patient care. This review seeks to provide a succinct and practical handbook for radiologists regarding both common and uncommon gastrointestinal devices. In addition to textual descriptions of clinical indications, imaging findings, complications, and MRI compatibility, the review incorporates a summary table as a quick reference point for key information and illustrative images for each device.

Diagnostic Accuracy of Artificial Intelligence-Based Algorithms in Automated Detection of Neck of Femur Fracture on a Plain Radiograph: A Systematic Review and Meta-analysis.

Objectives: To evaluate the diagnostic accuracy of artificial intelligence-based algorithms in identifying neck of femur fracture on a plain radiograph. Design: Systematic review and meta-analysis. Data sources: PubMed, Web of science, Scopus, IEEE, and the Science direct databases were searched from inception to 30 July 2023. Eligibility criteria for study selection: Eligible article types were descriptive, analytical, or trial studies published in the English language providing data on the utility of artificial intelligence (AI) based algorithms in the detection of the neck of the femur (NOF) fracture on plain X-ray. Main outcome measures: The prespecified primary outcome was to calculate the sensitivity, specificity, accuracy, Youden index, and positive and negative likelihood ratios. Two teams of reviewers (each consisting of two members) extracted the data from available information in each study. The risk of bias was assessed using a mix of the CLAIM (the Checklist for AI in Medical Imaging) and QUADAS-2 (A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies) criteria. Results: Of the 437 articles retrieved, five were eligible for inclusion, and the pooled sensitivity of AIs in diagnosing the fracture NOF was 85%, with a specificity of 87%. For all studies, the pooled Youden index (YI) was 0.73. The average positive likelihood ratio (PLR) was 19.88, whereas the negative likelihood ratio (NLR) was 0.17. The random effects model showed an overall odds of 1.16 (0.84-1.61) in the forest plot, comparing the AI system with those of human diagnosis. The overall heterogeneity of the studies was marginal (I2 = 51%). The CLAIM criteria for risk of bias assessment had an overall >70% score. Conclusion: Artificial intelligence (AI)-based algorithms can be used as a diagnostic adjunct, benefiting clinicians by taking less time and effort in neck of the femur (NOF) fracture diagnosis. Study registration: PROSPERO CRD42022375449. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-024-01130-6.

How to evaluate three dimensional angle error from plain radiographs.

Evaluating three-dimensional angle error is necessary because we cannot get every patient's CT or MRI at all times. Creating a method that can calculate angle error from plain radiographs is therefore important. Using vector and trigonometric mathematics, we gradually deduct our formula which can calculate angle error from goal angles (the angles we plan to achieve before operation) to result angles (the angles we get after operation) by two perpendicular radiographs. We also encode it into Micorsoft Excel (Redmond Campus, Redmond, Washington, U.S.) so that it becomes more user-friendly. We hope this tool can be used when evaluating TKR, corrective osteotomy, fracture fixation, and so on.

Rational Usage of Fracture Imaging in Children and Adolescents.

In this paper, authors introduce the basic prerequisite for rational, targeted, and above all, child-oriented diagnosis of fractures and dislocations in children and adolescents is in-depth prior knowledge of the special features of trauma in the growth age group. This review summarizes the authors' many years of experience and the state of the current pediatric traumatology literature. It aims to provide recommendations for rational, child-specific diagnostics appropriate to the child, especially for the area of extremity injuries in the growth age. The plain radiograph remains the indispensable standard in diagnosing fractures and dislocations of the musculoskeletal system in childhood and adolescence. Plain radiographs in two planes are the norm, but in certain situations, one plane is sufficient. X-rays of the opposite side in acute diagnostics are obsolete. Images to show consolidation after conservative treatment is rarely necessary. Before metal removal, however, they are indispensable. The upcoming diagnostical tool in pediatric trauma is ultrasound. More and more studies show that in elected injuries and using standardized protocols, fracture ultrasound is as accurate as plain radiographs to detect and control osseous and articular injuries. In acute trauma, CT scans have only a few indications, especially in epiphyseal fractures in adolescents, such as transitional fractures of the distal tibia or coronal shear fractures of the distal humerus. CT protocols must be adapted to children and adolescents to minimize radiation exposure. MRI has no indication in the detection or understanding of acute fractures in infants and children. It has its place in articular injuries of the knee and shoulder to show damage to ligaments, cartilage, and other soft tissues. Furthermore, MRI is useful in cases of remaining pain after trauma without radiological proof of a fracture and in the visualization of premature closure of growth plates after trauma to plan therapy. Several everyday examples of rational diagnostic workflows, as the authors recommend them, are mentioned. The necessity of radiation protection must be taken into consideration.