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Study Design. Retrospective analysis of prospectively collected data. Objective. To evaluate how preexisting adjacent segment degeneration status impacts revision risk for adjacent segment disease (ASD) after lumbar fusions. Summary of Background Data. ASD incurs late reoperations after lumbar fusion surgeries. ASD pathogenesis is multifactorial. Preexisting adjacent segment degeneration, measured by Pfirrmann, is suggested as one of the predisposing factors. We sought to find deeper insights into this association by using a more granular degeneration measure, the combined imaging score (CIS). Patients and Methods. A total of 197 consecutive lumbar fusions for degenerative pathologies were enrolled in a prospective follow-up (median: 12 yr). Preoperative cranial adjacent segment degeneration status was determined using Pfirrmann and CIS, which utilize both radiographs and magnetic resonance imaging. On the basis of CIS, patients were trichotomized into tertiles (CIS < 7, CIS 7-10, and CIS >10). The cumulative ASD revision risk was determined for each tertile. After adjusting for age, sex, body mass index, sacral fixation, and fusion length, hazard ratios (95% CI) for ASD revisions were determined for each Pfirrmann and CIS score. Results. Patients in the intermediate CIS tertile had a cumulative ASD revision risk of 25.4% (17.0%-37.0%), while both milder degeneration (CIS < 7) [13.2% (6.5%-25.8%)] and end-stage degeneration (CIS > 10) [13.6% (7.0%-25.5%)] appeared to be protective against surgical ASD. Pfirrmann failed to show a significant association with ASD revision risk. Adjusted analysis of CIS suggested increased ASD revisions after CIS 7, which turned contrariwise after CIS 10. Conclusions. The effect of preexisting adjacent segment degeneration on ASD reoperation risk is not linear. The risk appears to increase with advancing degeneration but diminishes with endstage degeneration. Therefore, end-stage degenerative segments may be considered to be excluded from fusion constructs. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective diagnostic study. Objectives. To evaluate the utility of quantitative assessment of bone density using proximal femoral morphological parameters based on full-spine x-rays. Summary of Background Data. CT and MRI are commonly utilized methods for opportunistic assessment of bone density. However, there is currently a lack of means to quantitatively assess bone density in adult spinal deformity (ASD) patients through radiographs. Methods. Data collection involved medical records of ASD patients treated at our hospital. Patients were categorized into osteoporotic and nonosteoporotic groups based on dual-energy xray absorptiometry T-scores. Demographic information, radiographic parameters (canal bone ratio, canal bone ratio (CBR); cortical bone thickness, cortical bone thickness (CBT)), Hounsfield units, and vertebral body quality (VBQ) scores were compared. Pearson correlation analysis was conducted to assess the correlation between CBR, CBT, and T-scores. Multiple linear regression analysis identified independent predictors of bone density T-scores. Receiver operating characteristic curves and area under the curve calculations were performed to investigate the predictive performance for osteoporosis. Results. A total of 102 patients were included, with the osteoporotic group showing larger CBR and smaller CBT compared with the nonosteoporotic group. Proximal femoral morphological parameters exhibited the strongest correlation with total hip T-scores. Advanced age (β = -0.028, 95% CI = -0.054 to -0.002, P = 0.032), low BMI (β = 0.07, 95% CI = 0.014-0.126, P = 0.015), and high CBR (β = -7.772, 95% CI = -10.519 to -5.025, P < 0.001) were identified as independent predictors of low bone density. Receiver operating characteristic analysis demonstrated that CBR had a similar osteoporosis screening capability as Hounsfield units, followed by CBT and VBQ scores. Conclusions. The utilization of CBR from full-spine x-rays is a simple and effective osteoporosis screening indicator for ASD patients, facilitating bone density assessments by spine surgeons for all attending patients. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Motion of lung tumors during radiotherapy leads to decreased accuracy of the delivered dose distribution. This is especially true for proton radiotherapy due to the finite range of the proton beam. Methods for mitigating motion rely on knowing the position of the tumor during treatment.Proton radiography uses the treatment beam, at an energy high enough to traverse the patient, to produce a radiograph. This work shows the first results of using an integrated‐mode proton radiography system to track the position of moving objects in an experimental phantom study; demonstrating the potential of using this method for measuring tumor motion.Proton radiographs of an anthropomorphic lung phantom, with a motor‐driven tumor insert, were acquired approximately every 1 s, using tumor inserts of 10, 20, and 30 mm undergoing a known periodic motion. The proton radiography system used a monolithic scintillator block and digital cameras to capture the residual range of each pencil beam passing through the phantom. These ranges were then used to produce a water equivalent thickness map of the phantom. The centroid of the tumor insert in the radiographs was used to determine its position. This measured position was then compared to the known motion of the phantom to determine the accuracy.Submillimeter accuracy on the measurement of the tumor insert was achieved when using a 30 mm tumor insert with a period of 24 s and was found to be improved for decreasing motion amplitudes with a mean absolute error (MAE) of 1.0, 0.9, and 0.7 mm for 20, 15, and 10 mm respectively. Using smaller tumor inserts reduced the accuracy with a MAE of 1.8 and 1.9 mm for a 20 and 10 mm insert respectively undergoing a periodic motion with an amplitude of 20 mm and a period of 24 s. Using a shorter period resulted in significant motion artifacts reducing the accuracy to a MAE of 2.2 mm for a 12 s period and 3.1 mm for a 6 s period for the 30 mm insert with an amplitude of 20 mm.This work demonstrates that the position of a lung tumor insert in a realistic anthropomorphic phantom can be measured with high accuracy using proton radiographs. Results show that the accuracy of the position measurement is the highest for slower tumor motions due to a reduction in motion artifacts. This indicates that the primary obstacle to accurate measurement is the speed of the radiograph acquisition. Although the slower tumor motions used in this study are not clinically realistic, this work demonstrates the potential for using proton radiography for measuring tumor motion with an increased scanning speed that results in a decreased acquisition time. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated stem subsidence following primary total hip arthroplasty (THA) with a Corail stem in patients who underwent two-staged bilateral THA. The second outcome of interest was to investigate whether a specific single cortical bone contact point might reduce postoperative stem subsidence. Methods: The present study was conducted following the STROBE guidelines. The records of patients who underwent THA between 2016 and 2023 were accessed. All patients who underwent two-staged bilateral THA were retrieved. The direct contact between the stem and the cortical bone was assessed at various points in the metaphysis and the distal portion of the stem (diaphysis) in both anteroposterior radiographs of the pelvis (medial and lateral bone contact) and a Lauenstein view of the hip (anterior and posterior bone contact). The following parameters were measured and compared to assess stem subsidence: distance from the proximal femur at the stem bone interface and the tip of the lesser trochanter (distance A); distance from the tip of the lesser trochanter and the tip of the femoral stem (distance B). Results: In total, 250 patients were included, 45% (149 of 250 patients) were women and 61% (153 of 250 THAs) were implanted primarily on the right side. The mean age of patients at the time of the first THA was 64.3 ± 10.0 years and the mean body mass index (BMI) was 28.0 ± 4.9 kg/m2. The mean length of the follow-up was 14.1 ± 10.8 months. The overall stem subsidence following THA was 2.8 ± 0.7 mm (P < 0.006). A direct cortical bone-implant contact did not exert a statistically significant difference in subsidence of the THA stem at the metaphysis and diaphysis (P > 0.5). Stem subsidence following THA with a collarless cementless Corail stem was approximately 2.8 mm at 14 months. Conclusions: Direct cortical bone contact of the stem at diaphysis and metaphysis seems not to influence stem subsidence following THA using the Corail stem. [ABSTRACT FROM AUTHOR]

Background: Predicting the progression of hip osteoarthritis (OA) remains challenging, and no reliable predictive method has been established. This study aimed to develop an artificial intelligence (AI) model to predict hip OA progression via plain radiographs and patient data and to determine its accuracy. Methods: This retrospective study utilized anteroposterior pelvic radiographs of consecutive patients with hip OA who underwent primary unilateral total hip arthroplasty. Radiographs diagnosed with Kellgren–Lawrence (KL) grade 0–2 were extracted from 361 patients and 1697 images. This AI model was developed to predict whether OA would progress from KL grade 0–2 to KL grade ≥ 3 within n years (n = 3, 4, 5). A gradient-boosting decision tree approach was utilized according to feature extractions obtained by a convolutional neural network from radiographs and patient data (height, body weight, sex, age, and KL grade given by an orthopedic surgeon) with five-fold cross-validation. The model performance was assessed using accuracy, specificity, sensitivity, and the area under the receiver operating characteristic curve (AUC). Results: The mean accuracy, specificity, sensitivity, and AUC of our prediction model were, respectively, 81.8%, 88.0%, 66.7%, and 0.836 for 3 years; 79.8%, 85.0%, 71.6%, and 0.836 for 4 years; and 78.5%, 80.4%, 76.9%, and 0.846 for 5 years. Conclusions: The proposed AI model performed adequately in predicting hip OA progression and may be clinically applicable with additional datasets and validation. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence To determine whether there is a correlation between preoperative coronal varus or valgus laxity and patient‐reported outcome measures (PROMs) 2 years after individualised total knee arthroplasty (TKA).Records of 150 consecutive patients who received individualised TKA were retrospectively analysed, and 126 with complete pre‐ and postoperative data were included. Preoperative coronal varus and valgus stress radiographs (15 N load) were taken using a telos stress device with the knee in 5°–10° of flexion. Varus stress angles were positive if the joint opened on the lateral side, and valgus stress angles were positive if the joint opened on the medial side. The sum of varus and valgus stress angles indicated total joint laxity. During surgery, cases that required tibial recuts to balance the joint were recorded. Patients completed three PROMs and rated their satisfaction. Correlations between laxity and PROMs were evaluated using Pearson's correlation.Stress radiographs revealed varus stress angles of 6.3° ± 3.5° (range, −4.5° to 14.1°), valgus stress angles of 0.1° ± 3.7° (range, −8.0° to 10.9°), and the sum of the varus and valgus stress angle of 6.4° ± 3.3° (range, 0.1° to 17.1°). There were no correlations between laxity and PROMs: r < 0.160 for varus stress angle, r < 0.180 for valgus stress angle and r < 0.160 for the sum of stress angles. There were no statistically significant or clinically relevant differences in PROMs between knees without and those with tibial recuts.Preoperative coronal varus or valgus laxity was not correlated with PROMs following individualised TKA at a minimum 2‐year follow‐up. Individualised TKA with personalised alignment enables adequate accommodation of a broad spectrum of preoperative coronal varus–valgus laxities.IV [ABSTRACT FROM AUTHOR]

Introduction: Kirschner wires are frequently employed in orthopedic procedures. While most complications are minor, rare instances of distant pin migration can occur. Such migration is more prevalent in the shoulder region but has been reported elsewhere. Case presentation: A 50-year-old Persian male with a right femoral neck fracture (Garden type IV) underwent closed reduction and internal fixation with three cannulated screws. During the procedure, a guide pin broke and remained lodged. Follow-up radiographs revealed the migrated pin in the patient's chest wall near the 11th rib, necessitating surgical removal via thoracotomy. Conclusion: This case underscores the potential for orthopedic implant migration. While often associated with smaller pins, the risk exists for all sizes. The timeframe for diagnosis varies significantly and in some cases it can be asymptomatic and discovered incidentally. [ABSTRACT FROM AUTHOR]

Objective: To investigate the early impact of plaque accumulation in a buccal dehiscence defect on peri‐implant marginal bone resorption. Materials and Methods: In six male Mongrel dogs, four dental implants were placed in the posterior maxilla on both sides (two implants per side). Based on the group allocation, each implant was randomly assigned to one of the following four groups to decide whether buccal dehiscence defect was prepared and whether silk ligation was applied at 8 weeks post‐implant placement for peri‐implantitis induction: UC (no defect without ligation); UD (defect without ligation); LC (no defect with ligation); and LD (defect with ligation) groups. Eight weeks after disease induction, the outcomes from radiographic and histologic analyses were statistically analyzed (p <.05). Results: Based on radiographs, the exposed area of implant threads was smallest in group UC (p <.0083). Based on histology, both the distances from the implant platform to the first bone‐to‐implant contact point and to the bone crest were significantly longer in the LD group (p <.0083). In the UD group, some spontaneous bone fill occurred from the base of the defect at 8 weeks after implant placement. The apical extension of inflammatory cell infiltrate was significantly more prominent in the LD and LC groups compared to the UC group (p <.0083). Conclusion: Plaque accumulated on the exposed implant surface had a negative impact on maintaining the peri‐implant marginal bone level, especially when there was a dehiscence defect around the implant. [ABSTRACT FROM AUTHOR]

Objective: Lower limb discrepancy (LLD) was frequently observed in patients with idiopathic scoliosis (IS), potentially associated with etiopathogenesis. Although sole lifts had been proposed as a conservative treatment for IS, evidence supporting their efficacy was limited. This study aimed to assess the effects of sole lift intervention on pediatric patients with mild IS, specifically focusing on thoracolumbar/lumbar (TL/L) curvature. Methods: Twenty patients, with an average age of 12.3 ± 3.1 years and presenting mild TL/L curve (15.6° ± 6.2°), were selected from a pool of 267 pediatric IS patients in the outpatient of our spine center from February 2023 to August 2023. Inclusion criteria comprised a main TL/L curve ranging between 10° and 40°, the lower limb positioned at the convexity of the main curve, and LLD of less than 2 cm; individuals requiring bracing or surgical intervention were excluded. Custom sole lifts were used to address the shorter lower limb with the objective of leveling the pelvis. Radiographic evaluations were conducted both before and after intervention using standing full spine posteroanterior radiographs and full leg length radiographs. Statistical analysis was undertaken to evaluate curve correction and its associations with other influencing factors. Results: The mean structural and functional LLD were 7.1 ± 4.5 mm and 7.1 ± 4.1 mm, respectively. Among the 20 patients, four exhibited structural LLD greater than 10 mm. The average follow‐up duration was 6.4 ± 1.9 months (range: 3–8 months). Following sole lift intervention (7.0 ± 3.0 mm), a significant reduction was observed in the TL/L curve compared to the pre‐sole lifting measurements (15.6° ± 6.2° vs. 12.1° ± 7.2°, p < 0.001), as well as a notable decrease in the thoracic curve (12.2° ± 4.0° vs. 8.6° ± 6.3°, p = 0.064). Nine patients experienced a significant curve reduction of ≥5°, while eight showed a reduction between 0° and 5°; however, two patients exhibited no change in curve magnitude. Furthermore, the correction rate of the TL/L curve correlated significantly with functional LLD (r = −0.484, p = 0.030) and pelvic obliquity (r = −0.556, p = 0.011), highlighting the active pelvic compensation in maintaining balance between the spine and lower limbs. Conversely, no significant correlation was observed between curve correction and structural LLD (p > 0.05). Additionally, even after adjusting for other influencing factors, the TL/L Cobb angle remained significantly different between pre‐ and post‐sole lifting (p = 0.037). Conclusion: This study confirmed the effectiveness of sole lift intervention in correcting TL/L and thoracic curves among the mild IS children with a main TL/L curve, providing a supplementary conservative treatment option for patients with the lower limb at the convexity of the main curve. Moreover, our findings underscored the active compensation of the lower limbs and the pelvis in the etiopathogenesis of IS, highlighting the importance of considering their influence in treatment strategies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify risk factors for subsequent meniscal surgery following anterior cruciate ligament (ACL) reconstruction (ACLR) in patients without recurrent ACL injury. Methods: Patients aged ≥14 years who underwent primary ACLR with minimum 1‐year follow‐up and without recurrent ACL injury were retrospectively reviewed. Patient demographics and surgical data at the time of ACLR were collected. Postoperative radiographs were used to measure femoral and tibial tunnel position, and posterior tibial slope. Univariate and multivariate analyses were performed to identify risk factors for subsequent meniscal surgery. Results: Of 629 ACLRs that fulfilled the inclusion criteria, subsequent meniscal surgery was performed in 65 [10.3%] patients. Multivariate analysis revealed that medial meniscal repair at the time of ACLR, younger age, anterior femoral tunnel position and distal femoral tunnel position were significantly associated with subsequent meniscal surgery (p < 0.001, p = 0.016, p = 0.015, p = 0.035, respectively). The frequency of femoral tunnel placement >10% outside of the literature‐established anatomic position was significantly higher in those who underwent subsequent meniscal surgery compared to those who did not (38.3% vs. 20.3%, p = 0.006). Posterior tibial slope and ACL graft type were not significantly associated with subsequent meniscal surgery. Conclusion: Medial meniscal repair at the time of ACLR, younger age and nonanatomic femoral tunnel placement were risk factors for subsequent meniscal surgery in patients without recurrent ACL injury. Femoral tunnel placement <10% outside of the native anatomic position is important to reduce the risk of subsequent meniscal surgery. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The demographic and radiological risk factors of subchondral insufficiency fractures of the knee (SIFK) continue to be a subject of debate. The purpose of this study was to associate patient‐specific factors with SIFK in a large cohort of patients. Methods: Inclusion criteria consisted of patients with SIFK as verified on magnetic resonance imaging (MRI). All radiographs and MRIs were reviewed to assess characteristics such as meniscus tear presence and type, subchondral oedema presence and location, location of SIFK, mechanical limb alignment, osteoarthritis as assessed by Kellgren–Lawrence grade and ligamentous injury. A total of 253 patients (253 knees) were included, with 171 being female. The average body mass index (BMI) was 32.1 ± 7.0 kg/m2. Results: SIFK was more common in patients with medial meniscus tears (77.1%, 195/253) rather than tears of the lateral meniscus (14.6%, 37/253) (p < 0.001). Medial meniscus root and radial tears of the posterior horn were present in 71.1% (180/253) of patients. Ninety‐one percent (164/180) of medial meniscus posterior root and radial tears had an extrusion ≥3.0 mm. Eighty‐one percent (119/147) of patients with SIFK on the medial femoral condyle and 86.8% (105/121) of patients with SIFK on the medial tibial plateau had a medial meniscus tear. Varus knees had a significantly increased rate of SIFK on the medial femoral condyle in comparison to valgus knees (p = 0.016). Conclusion: In this large cohort of patients with SIFK, there was a high association with medial meniscus root and radial tears of the posterior horn, meniscus extrusion ≥3.0 mm as well as higher age, female gender and higher BMI. Additionally, there was a particularly strong association of medial compartment SIFK with medial meniscus tears. As SIFK is frequently undiagnosed, identifying patient‐specific demographic and radiological risk factors will help achieve a prompt diagnosis. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The association between the prevalence of patellofemoral arthritis (PFA) and femoral tunnel positioning following isolated medial patellofemoral ligament reconstruction (MPFLr) has not been well described. The aim of this study was to analyse the relationship between femoral tunnel positioning and the prevalence of PFA. Methods: This was a single‐centre study of patients undergoing an isolated MPFLr between 2006 and 2011 with a minimum of 10 years of follow‐up. Outcomes assessed were the presence of PFA on radiographs, recurrence of instability requiring revision surgery and patient‐reported outcomes, including Kujala, Tegner and IKDC scores. Tunnel positioning was assessed on postoperative radiographs using two radiographic methods: Schöttle's point and the grid method to localise the femoral tunnel. Patients were grouped based on tunnel positioning and compared. Results: Fifty patients were analysed at a mean follow‐up of 12.4 years. Thirty‐three patients (66%) had a femoral tunnel position within 7 mm of Schöttle's point and 39 (78%) within the anatomic quadrant, with the most common location according to the grid method in D4 (28%) and E4 (26%), respectively. Thirty‐seven patients (74%) had a satisfactory (>80 versus <80) Kujala score at long‐term follow‐up. None of the examined tunnel assessment methods demonstrated a significant relationship with Tegner, Kujala or International Knee Documentation Committee scores. Patients with a femoral tunnel position >7 mm outside Schöttle's point or were considered to be in a nonanatomic position were not significantly more likely to result in unsatisfactory Kujala scores at the last follow‐up. Tunnel positioning and the other tested parameters were not found to be significantly associated with the development of PFA. Conclusion: No correlation between femoral tunnel position and risk of PFA or poor outcomes was observed in patients undergoing isolated MPFLr at long‐term follow‐up. The impact of femoral tunnel placement on long‐term outcomes in patients with PFI may be less significant than originally considered. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Different explosive materials have been studied numerically and experimentally to assess the efficiency of a small diameter shaped charge in terms of produced jet characteristics and penetration depth into RHA steel targets. 26 different explosives have been simulated numerically using Autodyn hydrocode, whereas recommended explosives have been loaded into small diameter shaped charges by pressing technique and tested by static firing against RHA targets in order to validate the numerical calculations. The numerical analysis has presented an intensive global view about the variation of the shaped charge jets as a potential of the loaded explosive charge efficiencies. A successful trial has been performed to measure the shaped charge jet velocity using detonation velocity VOD 812 apparatus, where its measured value was only 3.6% different from the numerical one for HMX-V5 explosive. Besides, TITAN (L3) flash X-ray radiograph has also been implemented to explore the jet profile using the same explosive type and to measure its jet tip velocity, which has only 2.1% different from that estimated numerically. Extensive fragmentation analysis has been presented, which showed increase in both the fragment number and the fragment speed when the used explosive charge is of high detonation velocity. CL-20 explosive exhibited the largest jet tip velocity and its scaled collapse velocity was found to be 140% of TNT explosive. The calculated average fragment speed has been validated and the measured fragment speed has only 2.3% difference when compared to the SPH calculations. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates the performance of a commercially available artificial intelligence (AI) system to identify normal chest radiographs and its potential to reduce radiologist workload. Methods: Retrospective analysis included consecutive chest radiographs from two medical centers between Oct 1, 2016 and Oct 14, 2016. Exclusions comprised follow-up exams within the inclusion period, bedside radiographs, incomplete images, imported radiographs, and pediatric radiographs. Three chest radiologists categorized findings into normal, clinically irrelevant, clinically relevant, urgent, and critical. A commercial AI system processed all radiographs, scoring 10 chest abnormalities on a 0–100 confidence scale. AI system performance was evaluated using the area under the ROC curve (AUC), assessing the detection of normal radiographs. Sensitivity was calculated for the default and a conservative operating point. the detection of negative predictive value (NPV) for urgent and critical findings, as well as the potential workload reduction, was calculated. Results: A total of 2603 radiographs were acquired in 2141 unique patients. Post-exclusion, 1670 radiographs were analyzed. Categories included 479 normal, 332 clinically irrelevant, 339 clinically relevant, 501 urgent, and 19 critical findings. The AI system achieved an AUC of 0.92. Sensitivity for normal radiographs was 92% at default and 53% at the conservative operating point. At the conservative operating point, NPV was 98% for urgent and critical findings, and could result in a 15% workload reduction. Conclusion: A commercially available AI system effectively identifies normal chest radiographs and holds the potential to lessen radiologists' workload by omitting half of the normal exams from reporting. Clinical relevance statement: The AI system is able to detect half of all normal chest radiographs at a clinically acceptable operating point, thereby potentially reducing the workload for the radiologists by 15%. Key Points: The AI system reached an AUC of 0.92 for the detection of normal chest radiographs. Fifty-three percent of normal chest radiographs were identified with a NPV of 98% for urgent findings. AI can reduce the workload of chest radiography reporting by 15%. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate and compare the clinico-radiographic outcomes between two techniques for acute Lisfranc fracture-dislocation with a large, displaced second metatarsal base plantar fracture: isolated Lisfranc screw fixation versus Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base. Methods: We retrospectively compared the clinico-radiographic outcome between patients who underwent isolated Lisfranc screw fixation (Group 1, 26 patients) and those who underwent Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base (Group 2, 23 patients). The main outcome measurements were the postoperative distance between the medial cuneiform and second metatarsal base on standing anteroposterior foot radiographs, known as the C1-M2 distance. Residual diastasis was defined as C1-M2 distance ≥ 2 mm on the affected side compared with that on the contralateral side. We also assessed the Foot and Ankle Ability Measure (FAAM)-activities of daily living (ADL) and sports subscale scores at three, six and ≥ 18 months postoperatively. Results: At the final follow-up, the mean C1-M2 distance on the affected side compared with that on the contralateral side was significantly greater in Group 1 than in Group 2 (3.9 versus 0.7 mm, P = 0.027). Furthermore, Group 1 showed a higher incidence of residual diastases at the final follow-up (69.2%) than the Group 2 (13.0%, P < 0.001). The FAAM-ADL scores at the final follow-up did not differ significantly between the groups (P = 0.518), but the FAAM Sports score was significantly higher in Group 2 than in Group 1 (P = 0.001). Conclusions: The postoperative C1-M2 distance was better maintained with Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base than with isolated Lisfranc screw fixation. We recommend that surgeons exercise caution when dealing with a second metatarsal plantar fracture and consider performing secure fixation using the dorsoplantar miniscrew technique for improved clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: Aims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient's first consultation at orthopaedic department. Materials and methods: This cross-sectional study examined radiographs from 850 patients, age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland–Altman plots, or intraclass coefficients. Results: A total of 850 patients with a mean age of 48.2 years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81). Conclusion: Calcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability. [ABSTRACT FROM AUTHOR]

Objectives: We developed the deep neural network (DNN) model to automatically measure hallux valgus angle (HVA) and intermetatarsal angle (IMA) on foot radiographs. The objective is to assess the accuracy of the model by comparing to the manual measurement of foot and ankle surgeons. Materials and methods: A DNN was developed to predict the bone axes of the first proximal phalanx and all metatarsals from the first to the fifth in foot radiographs. The dataset used for model development consisted of 1798 radiographs collected from a population-based cohort and patients at our foot and ankle clinic. The retrospective validation cohort comprised of 92 radiographs obtained from 92 consecutive patients visiting our foot and ankle clinic. The mean absolute error (MAE) between automatic measurements by the model and the median of manual measurements by three foot and ankle surgeons was compared to 3° using one-tailed t-test and was also compared to the inter-rater difference in manual measurements among the three surgeons using two-tailed paired t-test. Results: The MAE for HVA was 1.3° (upper limit of 95% CI 1.6°), and this was significantly smaller than the inter-rater difference of 2.0 ± 0.2° among the surgeons, demonstrating the superior accuracy of the model. In contrast, the MAE for IMA was 0.8° (upper limit of 95% CI 1.0°) that showed no significant difference from the inter-rater difference of 1.0 ± 0.1° among the surgeons. Conclusion: Our model demonstrated the ability to measure the HVA and IMA with an accuracy comparable to that of specialists. [ABSTRACT FROM AUTHOR]

Objective: To verify temporomandibular disorders (TMDs) and cervical angles in a young and middle-aged population. Methods: Ninety participants were included, 45 of whom had TMDs. The participants were diagnosed according to the Research Diagnostic Criteria for TMDs. Lateral cervical radiographs were taken, and relevant cervical angles were measured. The general characteristics of the TMD group and control group were analyzed using chi-square analysis, and the relationship between cervical angles and TMDs was evaluated using the unpaired t-test. Results: The decrease in C2–C7 Cobb and increase in the posterior occipitocervical angle (POCA) were associated with the incidence of TMDs (p < 0.0001). Conclusion: This study revealed that the cervical angle was related to TMDs. People with a long-time habit of head bending posture had a decrease in C2–C7 Cobb and an increase in the POCA. This group of people was more likely to develop TMDs. [ABSTRACT FROM AUTHOR]

Periapical radiography is a regular radiographic procedure performed by dentists. However, at times, it may not be possible to position the image receptor into a patient's mouth in an optimized or practical way. For these cases, some dentists advocated the use of extraoral periapical radiography (EOPA). This literature review aimed to review the dental literature on the use of EOPA. In October 2023, PubMed, Web of Science, and Scopus were searched to identify papers that reported on the use of EOPA, supplemented by manual reference tracing and Google Scholar searches. After screening, 18 papers published between 2003 and 2022 were identified, including 14 original articles and 4 reviews. From very limited and conflicting evidence, it was found that root length/working length measurements between EOPA and IOPA did not significantly differ or EOPA showed inferiority. No data were available to compare EOPA with other extraoral modalities such as panoramic radiography. The technique used in EOPA to visualize posterior teeth in the maxilla and mandible varied across studies, such as the vertical angulation of the primary beam, whether mouth should be opened or closed, and whether a holder should be used or not. At the current time, EOPA probably should not be advocated for regular use. [ABSTRACT FROM AUTHOR]

Tracheal collapse is a chronic and progressively worsening disease; the severity of clinical symptoms experienced by affected individuals depends on the degree of airway collapse. Cutting‐edge automated tools are necessary to modernize disease screening using radiographs across various veterinary settings, such as animal clinics and hospitals. This is primarily due to the inherent challenges associated with interpreting uncertainties among veterinarians. In this study, an artificial intelligence model was developed to screen canine tracheal collapse using archived lateral cervicothoracic radiographs. This model can differentiate between a normal and collapsed trachea, ranging from early to severe degrees. The you‐only‐look‐once (YOLO) models, including YOLO v3, YOLO v4, and YOLO v4 tiny, were used to train and test data sets under the in‐house XXX platform. The results showed that the YOLO v4 tiny‐416 model had satisfactory performance in screening among the normal trachea, grade 1–2 tracheal collapse, and grade 3–4 tracheal collapse with 98.30% sensitivity, 99.20% specificity, and 98.90% accuracy. The area under the curve of the precision–recall curve was >0.8, which demonstrated high diagnostic accuracy. The intraobserver agreement between deep learning and radiologists was κ = 0.975 (P <.001), with all observers having excellent agreement (κ = 1.00, P <.001). The intraclass correlation coefficient between observers was >0.90, which represented excellent consistency. Therefore, the deep learning model can be a useful and reliable method for effective screening and classification of the degree of tracheal collapse based on routine lateral cervicothoracic radiographs. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective analysis of prospectively collected data. Objectives: Isthmic spondylolisthesis (iSPL) occurs most commonly in L5/S1 and L4/5. This study investigates the association between spinopelvic anatomy and the pathogenesis of iSPL. Methods: Spinopelvic parameters as well as severity of slip grade were measured in sagittal spine radiographs of symptomatic patients with iSPL in segments L4/5 and L5/S1. Means were calculated and differences between both groups were analyzed. A correlation between the analyzed parameters and degree of slippage was performed. Results: We included 73 subjects in this study; 11 in L4/5 group and 62 in L5/S1 group. Pelvic anatomy significantly differed between L4/5 and L5/S1 iSPL (Pelvic Incidence (PI) 54.8° vs 66.3°, P value =.006; Pelvic Radius (PR) 124.4 mm vs 137.4 mm; P value =.005 and Sacral Table Angle (STA) 101.0° vs 92.2°, P value <.001). The relative degree of slippage was significantly higher in the L5/S1 group (L4/5 29.1% vs L5/S1 40.1%, P value.022). We also observed a significant correlation between pelvic anatomy and the severity of the slip in iSPL at the L5/S1 level. Conclusions: Pelvic parameters PI and STA play an important role concerning the level of occurrence and severity of iSPL. Spinopelvic anatomy determines the pathogenesis of iSPL. [ABSTRACT FROM AUTHOR]

Introduction: The acromiohumeral center-edge angle (ACEA) is a parameter that can be measured on plain shoulder radiographs and has been found to be associated with increased risk of sustaining a rotator cuff tear. Purpose: The aim of this study was to investigate this association using plain radiographs and to explore its applicability on shoulder magnetic resonance imaging (MRI) in the same patients. Methods: This retrospective study compared 45 patients who underwent rotator cuff repair between September 2021 and April 2022 and 41 patients with normal shoulders. The ACEA was measured by 2 independent observers on anteroposterior radiographs and shoulder MRI. The collected data were analyzed and P values of <.05 were considered statistically significant. Results: The ACEA was found to be higher in patients with rotator cuff tears (23.48° ± 7.11°) when compared with the control group (15.54° ± 4.4°). On shoulder MRI assessment, a higher ACEA was also seen in the rotator cuff tear group (18.93° ± 6.7°) than in the control group (13.79° ± 4.9°). The ACEA measurement on MRI showed strong intrarater reliability (0.965), but weak interrater reliability (0.251). Conclusion: This retrospective study found an association between increased ACEA and risk of rotator cuff tear when measured on plain radiographs. In addition, we found an association between increased ACEA measurement on shoulder MRI and rotator cuff tears, thus suggesting the applicability of ACEA measurement on shoulder MRI. [ABSTRACT FROM AUTHOR]

The aim of this Delphi study was to provide a diagnostic and treatment algorithm for patients with persistent or recurrent symptoms after trapeziometacarpal joint resection arthroplasty. Three Delphi rounds were conducted in which surveys were sent to 182 experienced hand surgeons worldwide. Responses were received from 140 participants. A consensus threshold was set at 67% agreement. Diagnostic tools and treatment approaches for six common revision scenarios achieved consensus. Radiographs are appropriate as primary (97%) and CT scans as secondary (76%) diagnostic tools. For scaphometacarpal impingement, 67% of respondents agreed that revision interposition is appropriate, with 93% recommending autologous tendon for the interposition. Additional suspension was considered appropriate by 68% of the participants. The diagnostic and treatment algorithm can help the surgeon to identify the reason for persistent symptoms after trapeziometacarpal joint resection arthroplasty and to choose an appropriate treatment strategy. Level of evidence: V [ABSTRACT FROM AUTHOR]

To overcome the limitation of a single classification model's inability to simultaneously identify multiple lesion targets within periapical radiographs, This study proposes YoCNET (Yolov5 + ConvNeXt), a novel deep learning integrated model. YoCNET leverages the target detection capability of Yolov5 and the image classification capability of ConvNeXt to achieve automatic segmentation of individual teeth and concurrent detection of periapical lesions across multiple teeth. A dataset of 1,305 periapical radiographs was used to train and validate the ConvNeXt and ResNet34 models, with an 8:2 split for training and validation. Deciduous teeth were excluded from the dataset. Furthermore, 717 individual teeth images were extracted from 200 previously unused periapical radiographs for integrated model validation. Evaluation metrics included accuracy, precision, sensitivity, F1 score, AUC (Area Under Curve), and a confusion matrix.The YoCNET integrated model demonstrated values of 90.93%, 98.88%, 85.30%, 0.9159, and 0.9757 for accuracy, precision, sensitivity, F1 score, and AUC, respectively. These metrics were superior to those achieved by the YoRNET (Yolov5 + ResNet34) integrated model, which recorded 80.47%, 83.78%, 82.16%, 0.8296, and 0.8822. The integrated model achieved high accuracy and efficiency in automatic teeh segmentation by Yolov5 and in automatically detecting multiple periapical lesions by ConvNeXt. YoCNET exhibited superior overall data performance, making it a more suitable deep learning integrated model for clinical applications. [ABSTRACT FROM AUTHOR]

Fracture healing is usually monitored by clinical impressions and radiographs. Objective and easy methods for assessing fracture healing without radiation would be beneficial. The aim of this study was to analyse whether weight and plantar pressure while standing can be used to monitor healing of tibial or malleolar fractures and whether these parameters can discriminate between patients with and without union. Thirteen patients were longitudinally assessed during each postoperative clinical visit, of whom two developed a nonunion. Eleven matched healthy controls were assessed once. Additionally, five patients already experiencing nonunion were assessed once at the time of their nonunion diagnosis. All participants performed a standing task for ten seconds with pressure-sensing insoles. Greatest improvements were detected throughout the first three months in patients with union. However, six months after surgery, more than half of the parameters were still significantly different from those of the controls. The weight and pressure distributions did not differ between patients with or without union six months after surgery. A standing task can be used to monitor improvements in weight and pressure distribution throughout the healing process of tibial or malleolar fractures, but lacks potential to discriminate between patients with or without fracture union. [ABSTRACT FROM AUTHOR]

The aim of this study was to propose a novel method to identify individuals by recognizing dentition change, along with human identification process using deep learning. Recent and past images of adults aged 20–49 years with more than two dental panoramic radiographs (DPRs) were assumed as postmortem (PM) and antemortem (AM) images, respectively. The dataset contained 1,029 paired PM-AM DPRs from 2000 to 2020. After constructing a database of AM dentition, the degree of similarity was calculated and sorted in descending order. The matched rank of AM identical to an unknown PM was measured by extracting candidate groups (CGs). The percentage of rank was calculated as the success rate, and similarity scores were compared based on imaging time intervals. The matched AM images were ranked in the CG with success rates of 83.2%, 72.1%, and 59.4% in the imaging time interval for extracting the top 20.0%, 10.0%, and 5.0%, respectively. The success rates depended on sex, and were higher for women than for men: the success rates for the extraction of the top 20.0%, 10.0%, and 5.0% were 97.2%, 81.1%, and 66.5%, respectively, for women and 71.3%, 64.0%, and 52.0%, respectively, for men. The similarity score differed significantly between groups based on the imaging time interval of 17.7 years. This study showed outstanding performance of convolutional neural network using dental panoramic radiographs in effectively reducing the size of AM CG in identifying humans. [ABSTRACT FROM AUTHOR]

Introduction: Narrowed tracheal lumen diameter (TLD) in dogs caused by congenital hypoplasia or acquired tracheal stenosis can result in adverse health effects. Standardized tracheal scores calculated from radiographic measurements have been used to assess tracheal diameter however comparisons have not been made to characterize differences in tracheal lumen among breeds. Methods: The main objective of this study was to compare tracheal scores at three regions of the trachea among non-brachycephalic dogs, non-bulldog brachycephalic dogs, and bulldogs. Medical records and thoracic radiographs of clinically normal dogs were reviewed. The TLDs 79 of three different tracheal regions (caudal cervical, thoracic inlet, and intrathoracic) were standardized by the manubrium length (ML) and thoracic inlet distance (Ti-D) to calculate the manubrium and thoracic inlet tracheal indexes (M-TI and Ti-TI) at each region. Statistical analysis was used to analyze the differences in tracheal scores among the three breed populations. Results: Overall, M-TI and Ti-TI varied significantly (p < 0.0001) at the three tracheal levels among the three breed populations. Bulldogs and non-bulldog brachycephalic breeds possessed lower (p < 0.016) M-TI and Ti-TI than nonbrachycephalic breeds at the three tracheal regions, and bulldogs possessed the lowest M-TI and Ti-TI scores at all measured regions. Conclusion: Averaged M-TIs <0.38, <0.34, <0.32 in non-brachycephalic, nonbulldog brachycephalic, and bulldog breeds, respectively, may indicate tracheal hypoplasia. Utilizing M-TI can be recommended for the assessment of canine TLD however further investigation in dogs with concurrent respiratory diseases is warranted. [ABSTRACT FROM AUTHOR]

Radiographic landmark annotation determines patients' anatomical parameters and influences diagnoses. However, challenges arise from ambiguous region-based definitions, human error, and image quality variations, potentially compromising patient care. Additionally, AI landmark localization often presents its predictions in a probability-based heatmap format, which lacks a corresponding clinical standard for accuracy validation. This Data Descriptor presents a clinical benchmark dataset for pelvic tilt landmarks, gathered through a probabilistic approach to measure annotation accuracy within clinical environments. A retrospective analysis of 115 pelvic sagittal radiographs was conducted for annotating pelvic tilt parameters by five annotators, revealing landmark cloud sizes of 6.04 mm-17.90 mm at a 95% dataset threshold, corresponding to 9.51°–16.55° maximum angular disagreement in clinical settings. The outcome provides a quantified point cloud dataset for each landmark corresponding to different probabilities, which enables assessment of directional annotation distribution and parameter-wise impact, providing clinical benchmarks. The data is readily reusable for AI studies analyzing the same landmarks, and the method can be easily replicated for establishing clinical accuracy benchmarks of other landmarks. [ABSTRACT FROM AUTHOR]

Background: Maxillary retrognathia and/or mandibular prognathia are resulting in class III malocclusion. Regarding orthodontic class III malocclusion treatment, the literature reports several treatment approaches. This comparative clinical study investigated two maxillary protraction protocols including bone anchors and Delaire type facemask. Methods: Cephalometric radiographs of n = 31 patients were used for data acquisition. The patients were divided into two groups according to their treatment protocol: bone anchored protraction (n = 12, 8 female, 4 male; mean age 11.00 ± 1.76 years; average application: 13.50 ± 5.87 months) and facemask protraction (n = 19, 11 female, 8 male; mean age 6.74 ± 1.15 years; average application: 9.95 ± 4.17 months). The evaluation included established procedures for measurements of the maxilla, mandibula, incisor inclination and soft tissue. Statistics included Shapiro-Wilk- and T-Tests for the radiographs. The level of significance was set at p < 0.05. Results: The cephalometric analysis showed differences among the two groups. SNA angle showed significant improvements during protraction with bone anchors (2.30 ± 1.18°) with increase in the Wits appraisal of 2.01 ± 2.65 mm. SNA angle improved also during protraction with facemask (1.22 ± 2.28°) with increase in the Wits appraisal of 1.85 ± 4.09 mm. Proclination of maxillary incisors was larger in patients with facemask (3.35 ± 6.18°) and ML-SN angle increased more (1.05 ± 1.51°) than in patients with bone anchors. Loosening rate of bone anchors was 14.58%. Conclusions: Both treatment protocols led to correction of a class III malocclusion. However, this study was obtained immediately after protraction treatment and longitudinal observations after growth spurt will be needed to verify the treatment effects over a longer period. The use of skeletal anchorage for maxillary protraction reduces unwanted side effects and increases skeletal effects needed for class III correction. [ABSTRACT FROM AUTHOR]

Introduction: The veterinary yearling pre-sale repository radiographs have the potential to impact both vendor and prospective purchaser. The primary aim of this study was to determine inter-observer agreement for orthopaedic lesions identified in thoroughbred yearling repository radiographs. A secondary goal was to determine agreement when using a pre-defined risk rating classification. Methods: Three experienced specialist equine surgeons (2 ACVS & 1 FANZCVS) interpreted thirty repository radiographs once each for radiographic abnormalities. Each radiographic abnormality was given an associated risk assessment for future racing performance. Results: The use of a pre-defined risk rating grading scale resulted in good to excellent agreement as observers reached a consensus on risk ratings for lesions 97.1% of the time. The highest agreement was for the proximal interphalangeal joint and distal interphalangeal joint, with 99.9 and 98.2% agreement, respectively. The tarsal region was the joint with the highest disagreement with respect to pathology, with observers disagreeing 5.2% of the time. Discussion: This study found that experienced veterinary surgeons reliably agreed on the absence of lesions but showed disagreement on the specific risk rating of common lesions. [ABSTRACT FROM AUTHOR]

Background/Objectives: The integration of AI into dentistry holds promise for improving diagnostic workflows, particularly in the detection of dental pathologies and pre-radiotherapy screening for head and neck cancer patients. This study aimed to develop and validate an AI model for detecting various dental conditions, with a focus on identifying teeth at risk prior to radiotherapy. Methods: A YOLOv8 model was trained on a dataset of 1628 annotated panoramic radiographs and externally validated on 180 radiographs from multiple centers. The model was designed to detect a variety of dental conditions, including periapical lesions, impacted teeth, root fragments, prosthetic restorations, and orthodontic devices. Results: The model showed strong performance in detecting implants, endodontic treatments, and surgical devices, with precision and recall values exceeding 0.8 for several conditions. However, performance declined during external validation, highlighting the need for improvements in generalizability. Conclusions: YOLOv8 demonstrated robust detection capabilities for several dental conditions, especially in training data. However, further refinement is needed to enhance generalizability in external datasets and improve performance for conditions like periapical lesions and bone loss. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis, a systemic skeletal disorder, is expected to affect 60% of women over 50. While dual-energy X-ray absorptiometry (DXA) scans are the current gold standard for diagnosis, they are typically used only after fractures occur, highlighting the need for early detection tools. Initial studies have shown panoramic radiographs (PRs) to be a potential medium, but these have methodological flaws. This study aims to address these shortcomings by developing a robust AI application for accurate osteoporosis identification in PRs. Methods: A total of 348 PRs were used for development, 58 PRs for validation, and 51 PRs for hold-out testing. Initially, the YOLOv8 object detection model was employed to predict the regions of interest. Subsequently, the predicted regions of interest were extracted from the PRs and processed by the EfficientNet classification model. Results: The model for osteoporosis detection on a PR achieved an overall sensitivity of 0.83 and an F1-score of 0.53. The area under the curve (AUC) was 0.76. The lowest detection sensitivity was for the cropped angulus region (0.66), while the highest sensitivity was for the cropped mental foramen region (0.80). Conclusion: This research presents a proof-of-concept algorithm showing the potential of deep learning to identify osteoporosis in dental radiographs. Furthermore, our thorough evaluation of existing algorithms revealed that many optimistic outcomes lack credibility when subjected to rigorous methodological scrutiny. [ABSTRACT FROM AUTHOR]

AbstractAdult-acquired flatfoot causes various deformities. If a patient-specific foot model can be created using the finite element method, it can be used to study the appropriate surgical technique for each patient. Nine patient-specific flatfoot models were created, and loading simulations were performed. To validate the models, the patients’ weight-bearing radiographs were compared with the parameters of the models. The CCC values ranged from 0.917 to 0.993 , all exceeding the moderate threshold according to the McBride criteria. Our model reproduces the biomechanics of a patient’s foot under loading conditions, which may be useful for investigating patient-specific surgical procedures. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this multicenter retrospective study was to perform a two-dimensional analysis of upper airway changes in adolescent patients following molar distalization with the Pendulum appliance. Materials and methods: The study involved the cephalometric analysis of 88 patients, retrospectively categorized into two groups: skeletal Class II with a dental Class II molar relationship (36 patients, mean age 12.6 ± 1.1 years) and skeletal Class I with a dental Class II molar relationship (54 patients, mean age 12.3 ± 1.2 years). Changes were observed using lateral radiographs before (T0) and after Pendulum appliance removal (T1); treatment time averaged 7 months. Upper airways were subsequently analyzed by tracing lateral radiographs. The Shapiro-Wilk test showed a normal distribution of the data, therefore parametric tests were used for statistical analysis. Intragroup changes between T0 and T1 were evaluated using paired t-tests, and intergroup differences were assessed using independent student t-tests; statistical significance was set at 0.05. Results: Statistically significant differences were observed in the skeletal measurements that characterized both groups, particularly in ANB and Wits appraisal, at T0 (P < 0.001). After molar distalization, Class I and Class II groups reported no statistically significant differences with changes almost equal to zero between timepoints (P > 0.05). Additionally, intergroup comparisons of airway changes at T1 did not show statistically significant differences (P > 0.05). Conclusions: The Pendulum appliance does not significantly change the upper airway dimensions in Class I and Class II malocclusion patients, thereby minimizing potential respiratory risks. [ABSTRACT FROM AUTHOR]

Introduction: Proximal femoral nailing (PFN) offers biomechanical benefits for intertrochanteric fractures but can lead to higher complication rates from poor reduction and technique errors, particularly in obese patients. Incorrect entry points may cause reduction loss, iatrogenic fractures, and misplaced lag screws. The study aims to investigate the effect of using an oriented flexible reamer instead of a rigid reamer on clinical and radiological results to obtain a medial entry point and better positioning of the nail in the intramedullary area in obese intertrochanteric fracture patients. Materials and methods: A retrospective analysis was conducted on patients aged 65 years and older who underwent PFN treatment between March 2020 and June 2022 at a single institution, with at least 1-year postoperative follow-up. Patients were divided into two groups: those applied with a flexible reamer and a rigid reamer. Parameters analyzed from postoperative radiographs included tip-apex distance (TAD), calcar-referenced tip-apex distance (CalTAD), reduction quality, femoral neck-shaft angle, and lag screw placement. Complication rates and types were recorded for each group. Result: The analysis included 91 patients, with 45 treated using a flexible reamer and 46 treated using a rigid reamer. There was no statistical difference between the two groups regarding age, gender, BMI, and AO class distributions of the patients (p > 0.05). The Femur neck shaft angle was significantly higher in the flexible reamer group (p < 0.001). As a result of the reduction types analysis, medial type reduction was significantly higher in the group where the flexible reamer was applied (p < 0.001). The CalTAD was shorter in the Flexible reamer group (p = 0.005). Complications and the need for reoperation were statistically significantly higher in the rigid reamer group (p < 0.048). Conclusion: The oriented flexible reamer reduces application-related errors in patients undergoing proximal femoral nail (PFN) treatment due to intertrochanteric fracture. The oriented flexible reamer technique allows a more medial entry point. Oriented flexible reamer creates enough space on both fracture sides at the level of intertrochanteric fracture to avoid nail pass-related complications. Level of evidence: Level III, Case-control study. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions CT examinations commonly start with the acquisition of one or two localizer radiographs (2D localizers). Recently, a manufacturer introduced the option to perform a heavily filtrated low‐dose helical scan as a localizer acquisition. To compare the dose of one or two 2D localizer acquisitions to the dose of a 3D localizer acquisition, one cannot simply compare the CTDIs of the different acquisition techniques, because of the use of different geometries and spectra.To compare the organ and effective dose for various CT localizer acquisition techniques.A Geant4‐based Monte Carlo simulation, replicating a clinical wide‐area CT scanner was developed and validated. Various localizer acquisition strategies were simulated: Anterior‐posterior (AP) alone, PA alone, combined AP+lateral (LAT), and PA+LAT 2D localizers, and an Ag‐filtered 3D localizer acquisition. Validation was performed by measuring and simulating CTDI100 in both the periphery and the center of a CTDI phantom. The software was subsequently used to estimate organ and effective doses for localizers for chest, abdomen + pelvis, and the combined chest, abdomen, and pelvis exams. As representations of patients, eight ICRP computational phantoms (adult, 15‐, 10‐, and 5‐year, both male and female) and five female and five male XCAT phantoms with various BMIs were used. The dose of the various strategies was compared to the current clinically‐implemented AP+LAT localizers.CTDI100‐measurements and simulations within the CTDI‐phantom differs by a maximum of 8.1% and by an average of 0.9%. For chest, the average effective doses for AP, PA, AP+LAT, and the 3D localizer are 0.10, 0.07, 0.32, and 0.22 mSv, respectively. The organ dose to the breast varies the most across the various localizer strategies and is, on average, 0.17, 0.03, 0.44, and 0.33 mGy, in the same order. For abdomen, the average effective doses are 0.11, 0.07, 0.36, and 0.25 mSv for the AP, PA, AP+LAT and the 3D localizer, respectively. The organ dose to the stomach varies the most across the various localizers and is on average 0.14, 0.08, 0.58, and 0.30 mGy, in the same order. The PA‐only localizer results in the lowest organ dose to the most radiosensitive organs and the lowest effective dose. For the chest exam, compared to AP+LAT, the PA+LAT results in a 7 ± 2% effective dose reduction (mean ± standard deviation), while the 3D localizer results in a 21 ± 3% effective dose reduction. Using AP or PA only would result in 69 ± 2% and 76 ± 2% reduction, respectively. For the abdomen exam, also compared to AP+LAT, PA+LAT results in 6 ± 2% effective dose reduction, while the 3D localizer results in a 20 ± 5% reduction. Using AP or PA only would result in 69 ± 5% and 76 ± 4% reduction, respectively.Using a PA localizer results in a lower or equivalent organ dose in the most radiosensitive organs, and a lower effective dose compared to an AP localizer for both chest and abdomen+pelvis exams. Compared to a two‐localizer strategy, the 3D localizer results in a lower effective dose in both the chest and abdomen+pelvis region. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusion Hypophosphatasia (HPP) is a rare inherited disease that affects multiple organ systems including bone and teeth. Limited knowledge exists on dental and oral health in patients with adult‐onset HPP (aHPP).The aim of this study was to investigate oro‐dental characteristics in patients with aHPP compared to healthy controls.This case‐control study included 20 patients with aHPP compared to 31 healthy controls. Oro‐dental manifestations were examined by standardised interviews, clinical examinations as well as radiological registrations on panoramic radiograph (OP) and cone‐beam computed tomography (CBCT) scans.The subjective experience of tooth fractures (p = 0.010), caries in permanent teeth (p = 0.032) and early loss of permanent teeth (p = 0.002) was significantly higher in patients with aHPP compared to the controls. In the aHPP group, the presence of specific teeth (p ≤ 0.045) and attrition of 11 were significantly lower (p = 0.012) compared to the controls. Opacity of a few teeth (p ≤ 0.049), presence of denticles (p = 0.024), the distance between the enamel–cement junction (CEJ) and the marginal bone level at specific sites (p ≤ 0.021) and crown height of 11 (p = 0.017) were significantly higher in patients with aHPP than in healthy controls.The results indicate that patients with aHPP have a subjective experience of having poorer dental health. Loss of permanent teeth, less attrition, tooth opacities, denticles and larger distance between CEJ and marginal bone level are possible oro‐dental findings in patients with aHPP. [ABSTRACT FROM AUTHOR]

Objective: The aim is to detect impacted teeth in panoramic radiology by refining the pretrained MedSAM model. Study design: Impacted teeth are dental issues that can cause complications and are diagnosed via radiographs. We modified SAM model for individual tooth segmentation using 1016 X-ray images. The dataset was split into training, validation, and testing sets, with a ratio of 16:3:1. We enhanced the SAM model to automatically detect impacted teeth by focusing on the tooth's center for more accurate results. Results: With 200 epochs, batch size equals to 1, and a learning rate of 0.001, random images trained the model. Results on the test set showcased performance up to an accuracy of 86.73%, F1-score of 0.5350, and IoU of 0.3652 on SAM-related models. Conclusion: This study fine-tunes MedSAM for impacted tooth segmentation in X-ray images, aiding dental diagnoses. Further improvements on model accuracy and selection are essential for enhancing dental practitioners' diagnostic capabilities. [ABSTRACT FROM AUTHOR]

CR-39 proton radiography is an experimental charged-particle backlighter platform fielded and used at OMEGA and the NIF to image electric and magnetic fields in a subject plasma. Processing a piece of CR-39 involves etching it in hot NaOH, and the etch time can greatly impact the background-to-signal ratio (BSR) in low-fluence (≲4 × 104 cm−2) regions and detection efficiency in high-fluence regions (≳7 × 105 cm−2). For CR-39 data with high fluence variation, these effects mean that any single etch time will result in ≳15% error in the measured signal in either the high- or low-fluence regions. This study aims to quantify the impact of the etch time on the BSR and efficiency losses and how these affect the field reconstruction. Experiments at the MIT Linear Electrostatic Ion Accelerator provided empirical values of the BSR and efficiency losses as a function of the fluence and etch time for fluences ranging from 3 × 103 to 7 × 105 cm−2. Synthetic radiographs were generated with known fields and modulated based on empirical values of BSR and efficiency losses. The fields were reconstructed using a Monge–Ampère code with the modulated radiographs as input. The results indicate that combining short and long etches allows for more accurate analysis of radiographs with high fluence variation, with the mean squared error of the reconstructed fields decreasing by factors of 1.2–7 compared to the reconstructions using only one etch time. [ABSTRACT FROM AUTHOR]

Spondylolisthesis is a common condition with a prevalence of 4–6% in childhood and 5–10% in adulthood. The Meyerding Classification, developed in 1932, assigns grades (I to V) based on the degree of slippage observed on standing, neutral lateral lumbar radiographs. Despite its historical significance and reliability, more factors should be evaluated to predict spondylolisthesis progression, especially in low-grade cases. The manuscript highlights areas for improvement in spondylolisthesis classification, emphasizing the need for considering factors beyond vertebral slippage. Factors such as global and segmental alignment, pelvic incidence, overhang, the number of affected levels, and the use of lateral flexion-extension radiographs to assess for stability using the kyphotic angle and slippage degree are identified as crucial in predicting progression and determining effective management strategies. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic incidence (PI) is commonly used to determine sagittal alignment. Historically, PI was believed to be a fixed anatomic parameter. However, recent studies have suggested that there is positionally-dependent motion that occurs through the sacroiliac joint (SIJ) resulting in changes in PI. Methods: We reviewed 100 consecutive adult spinal deformity (ASD) patients seen at our academic tertiary referral center. Two reviewers measured pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) on standing radiographs and scout computed tomography scans (CT). Unilateral, bilateral, or absent SIJ vacuum sign (VS) was determined using CTs. Results: Eighty-six patients (42 M:44 F) were included with an average age of 64.1 years and BMI of 28.8 kg/m2. Standing PI was low (< 50°) in 35 patients (40.7%), average (50°-60°) in 22 (25.6%), and high (> 60°) in 29 (33.7%). Average and high PI patients had significant PI changes of 3.0° (p = 0.037) and 4.6° (p = 0.005), respectively. Bilateral SIJ VS was seen in 68 patients, unilateral VS in 9, and VS was absent in 9. The average change in PI between standing and supine was 2.1° in bilateral SIJ VS patients (p = 0.045), 2.2° in unilateral SIJ VS (p = 0.23), and − 0.1° in patients without SIJ VS (p = 0.93). The average absolute difference in PI between supine and standing was 5.5° ±5.5° (p < 0.001). Conclusion: There is a change in PI from supine to standing. In patients with high PI and bilateral VS on CT, the change from supine to standing is significant, perhaps representing instability of the SIJ. [ABSTRACT FROM AUTHOR]

Objective: To compare the functional and radiological outcomes of Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) treatments for patients with unstable intertrochanteric fractures. Study Design: Comparative study. Setting: Trauma Centre, Hayatabad Medical Complex Peshawar. Period: May 2020 to June 2022. Methods: The study comprised 150 patients aged over 40 years old and had Type 2 intertrochanteric fractures, as classified by Boyd and Griffin. Radiographs, functional assessments, and demographic information were collected and patients were followed for up to two years at regular intervals. Results: The mean age of patients was 70 years. The PFN group had significantly shorter surgery duration (57.47 minutes) compared to the DHS group (85.30 minutes), less blood loss (74 ml vs. 195 ml), and a shorter hospital stay (6.5 days vs. 11.8 days). Early weight bearing was achieved faster in the PFN group, with mean times to partial and full weight bearing of 3.12 and 8.45 weeks, respectively, compared to 5.52 and 12.32 weeks in the DHS group. Radiological union at three months was significantly better in the PFN group. Complications were fewer in the PFN group, with notable differences in screw cutout, migration, and backout rates. Pain levels were lower in the PFN group at three and six months post-operatively. Conclusion: PFN demonstrated superior outcomes in terms of reduced surgical time, blood loss, hospital stay, and faster weight-bearing capabilities compared to DHS. Radiological and functional outcomes also favoured PFN, making it a preferable option for treating unstable intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

Background: Management of syndesmotic injuries with screw fixation has potential disadvantages, which may lead to the loss of some of the ankle functions. The use of the suture-button system instead can overcome these disadvantages. Patients and methods: In a prospective study, 32 patients with acute isolated syndesmotic injuries were treated with a suture-button device. Follow-up was for a minimum of 2 years, regarding the Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, patient satisfaction at 3, 12, and 24 months, and radiological assessment. Result: A significant improvement regarding pain (VAS during rest 5.6 and during walking 6.1 preoperative improved to 0.1 and 0.2 postoperatively, respectively. (P values were < 0.0001 for both pain during rest and walking) and AOFAS score (improved significantly from 44 ± 7.5 pre- to 99 ± 8.7 points postoperatively (P value was 0.0034). The improved VAS and AOFAS scores of the repaired ankles gradually reached the values of the contralateral uninjured ankle (evaluated at 3,12, and 24 months, postoperatively). Radiographs and CT of both ankles - repaired and healthy ankles - were similar at the 3 months follow-up. Early full weight-bearing and early return to work and sport characterized all patients. There was no need for hardware removal. Conclusion: Suture-button treatment for acute isolated ankle syndesmotic injuries leads to favorable clinical and radiological outcomes. Postoperative radiographs and CT denoted maintained ankle stability. Patients can do early full weight-bearing and early return to work and sport. [ABSTRACT FROM AUTHOR]

Availability of pertinent and detailed information for damaged ancient objects is vital for successful restorative, damage limitation intervention processes in archeology. Visual inspection and radiography testing (RT) constitute widely used non-destructive methods for conservators of such objects. Unfortunately, the quality of RT images is susceptible to blurring caused by the superimposed scattered X-rays. In this study, the no-black-pixel constraint (NBPC) algorithm on its own as well as in the form of an algorithm with the planar-scene assumption (NBPC + PA) was applied to RT images with a view to suppressing image blurring and enhancement of imaging contrast. The results of this study have shown, both qualitatively and quantitatively that the NBPC + PA and NBPC algorithms provide higher imaging contrast for identification and evaluation of damage in corroded ancient metallic relics than using unprocessed RT images alone. Contrast enhancement of up to about 120% and 78% was achieved in comparison with the original image by applying the NBPC+PA and NBPC algorithms, respectively. Practical application and effectiveness of using the processed images were evaluated by expert operators in the area and it was found that using the reconstructed images scored higher (on average by 88%) than the original RT images (on average by 73%) with the NBPC+PA scoring higher (on average by 91%) than the NBPC algorithm (on average by 85%). The operators have found utilizing the processed images leads to better inspection and evaluation of the object enabling better targeted informed for restorative intervention, damage limitation, and maintenance of such objects. [ABSTRACT FROM AUTHOR]

Syagrus coronata, a native palm tree in the Caatinga domain, produces fixed oil (ScFO) used therapeutically and dietary by Northeast Brazilian communities. This study evaluated its anti-inflammatory potential of CFA-induced arthritis and its effect on behavioral parameters. In the acute model, ScFO at 25, 50, and 100 mg/kg showed edematogenic effects similar to indomethacin at 4 mg/kg (p > 0.05). In the arthritis model, 100 mg/kg ScFO treatment was comparable to indomethacin (4 mg/kg) (p > 0.05). TNF-α and IL-1β levels were significantly reduced in ScFO-treated groups at 25, 50, and 100 mg/kg, and the indomethacin group (4 mg/kg) versus the positive control (p > 0.05). Radiographs showed severe soft-tissue swelling and bone deformities in the control group, while the 100 mg/kg ScFO group had few alterations, similar to the indomethacin group. Histopathological analysis revealed intense lymphocytic infiltration in the control group, mild diffuse lymphocytic infiltration in the indomethacin group, and mild lymphoplasmacytic infiltration with focal polymorphonuclear infiltrates in the 100 mg/kg ScFO group. Behavioral analysis showed improved exploratory stimuli in ScFO and indomethacin-treated mice compared to the positive control (p > 0.05). ScFO demonstrated anti-inflammatory effects in both acute and chronic arthritis models, reducing edema and pro-inflammatory cytokines, and improved exploratory behavior due to its analgesic properties. [ABSTRACT FROM AUTHOR]

Chest radiography is a frequently used imaging modality in children. However, only fair to moderate inter-observer agreement has been reported between chest radiograph interpreters. Most studies were not performed in real-world clinical settings. Our aims were to examine the agreement between emergency department pediatricians and board-certified radiologists in a pediatric real-life setting and to identify clinical risk factors for the discrepancies. Included were children aged 3 months to 18 years who underwent chest radiography in the emergency department not during the regular hours of radiologist interpretation. Every case was reviewed by an expert panel. Inter-observer agreement between emergency department pediatricians and board-certified radiologists was assessed by Cohen's kappa; risk factors for disagreement were analyzed. Among 1373 cases, the level of agreement between emergency department pediatricians and board-certified radiologists was "moderate" (k = 0.505). For radiographs performed after midnight, agreement was only "fair" (k = 0.391). The expert panel identified clinically relevant disagreements in 260 (18.9%) of the radiographs. Over-treatment of antibiotics was identified in 121 (8.9%) of the cases and under-treatment in 79 (5.8%). In a multivariable logistic regression, the following parameters were found to be significantly associated with disagreements: neurological background (p = 0.046), fever (p = 0.001), dyspnea (p = 0.014), and radiographs performed after midnight (p = 0.007). Conclusions: Moderate agreement was found between emergency department pediatricians and board-certified radiologists in interpreting chest radiographs. Neurological background, fever, dyspnea, and radiographs performed after midnight were identified as risk factors for disagreement. Implementing these findings could facilitate the use of radiologist expertise, save time and resources, and potentially improve patient care. What is Known: • Only fair to moderate inter-observer agreement has been reported between chest radiograph interpreters. • Most studies were not performed in real-world clinical settings. Clinical risk factors for disagreements have not been reported. What is New: • In this study, which included 1373 cases at the emergency department, the level of agreement between interpreters was only "moderate." • The major clinical parameters associated with interpretation discrepancies were neurological background, fever, dyspnea, and interpretations conducted during the night shift. [ABSTRACT FROM AUTHOR]

Objectives: To improve pubertal bone age (BA) evaluation by developing a precise and practical elbow BA classification using the olecranon, and a deep-learning AI model. Materials and methods: Lateral elbow radiographs taken for BA evaluation in children under 18 years were collected from January 2020 to June 2022, retrospectively. A novel classification and the olecranon BA were established based on the morphological changes in the olecranon ossification process during puberty. The olecranon BA was compared with other elbow and hand BA methods, using intraclass correlation coefficients (ICCs), and a deep-learning AI model was developed. Results: A total of 3508 lateral elbow radiographs (mean age 9.8 ± 1.8 years) were collected. The olecranon BA showed the highest applicability (100%) and interobserver agreement (ICC 0.993) among elbow BA methods. It showed excellent reliability with Sauvegrain (0.967 in girls, 0.969 in boys) and Dimeglio (0.978 in girls, 0.978 in boys) elbow BA methods, as well as Korean standard (KS) hand BA in boys (0.917), and good reliability with KS in girls (0.896) and Greulich–Pyle (GP)/Tanner–Whitehouse (TW)3 (0.835 in girls, 0.895 in boys) hand BA methods. The AI model for olecranon BA showed an accuracy of 0.96 and a specificity of 0.98 with EfficientDet-b4. External validation showed an accuracy of 0.86 and a specificity of 0.91. Conclusion: The olecranon BA evaluation for puberty, requiring only a lateral elbow radiograph, showed the highest applicability and interobserver agreement, and excellent reliability with other BA evaluation methods, along with a high performance of the AI model. Clinical relevance statement: This AI model uses a single lateral elbow radiograph to determine bone age for puberty from the olecranon ossification center and can improve pubertal bone age assessment with the highest applicability and excellent reliability compared to previous methods. Key Points: Elbow bone age is valuable for pubertal bone age assessment, but conventional methods have limitations. Olecranon bone age and its AI model showed high performances for pubertal bone age assessment. Olecranon bone age system is practical and accurate while requiring only a single lateral elbow radiograph. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate an artificial intelligence (AI) system for measuring and detecting signs of carpal instability on conventional radiographs. Materials and methods: Two case-control datasets of hand and wrist radiographs were retrospectively acquired at three hospitals (hospitals A, B, and C). Dataset 1 (2178 radiographs from 1993 patients, hospitals A and B, 2018–2019) was used for developing an AI system for measuring scapholunate (SL) joint distances, SL and capitolunate (CL) angles, and carpal arc interruptions. Dataset 2 (481 radiographs from 217 patients, hospital C, 2017–2021) was used for testing, and with a subsample (174 radiographs from 87 patients), an observer study was conducted to compare its performance to five clinicians. Evaluation metrics included mean absolute error (MAE), sensitivity, and specificity. Results: Dataset 2 included 258 SL distances, 189 SL angles, 191 CL angles, and 217 carpal arc labels obtained from 217 patients (mean age, 51 years ± 23 [standard deviation]; 133 women). The MAE in measuring SL distances, SL angles, and CL angles was respectively 0.65 mm (95%CI: 0.59, 0.72), 7.9 degrees (95%CI: 7.0, 8.9), and 5.9 degrees (95%CI: 5.2, 6.6). The sensitivity and specificity for detecting arc interruptions were 83% (95%CI: 74, 91) and 64% (95%CI: 56, 71). The measurements were largely comparable to those of the clinicians, while arc interruption detections were more accurate than those of most clinicians. Conclusion: This study demonstrates that a newly developed automated AI system accurately measures and detects signs of carpal instability on conventional radiographs. Clinical relevance statement: This system has the potential to improve detections of carpal arc interruptions and could be a promising tool for supporting clinicians in detecting carpal instability. Key Points: Artificial intelligence can accurately measure and detect signs of carpal instability on conventional radiographs. It measures scapholunate distances, scapholunate and capitolunate angles, and detects carpal arc interruptions. The measurement accuracy was largely comparable to five clinicians with different specialties, and the arc interruption detections were more accurate than most clinicians. All measurements and detections are explainable, and a new heat map technique was developed for visualizing the degree and location of carpal arc interruptions in the image. [ABSTRACT FROM AUTHOR]

Musculoskeletal hydatid disease is rare and can be located anywhere but most commonly the bone and muscles of the spine, pelvis, then the lower limbs. Imaging is essential for its diagnosis, performing the pre-therapeutic assessment, guiding possible percutaneous treatments, and providing post-therapeutic follow-up. Musculoskeletal hydatidosis can take several forms that may suggest other infections and tumors or pseudotumors. MRI and CT are superior for its diagnosis but ultrasound and radiography remain the most accessible examinations in developing countries where this parasitosis is endemic. In this review, we provide an overview of this disease and describe its different imaging patterns in soft tissue and bone involvement that should be sought to support the diagnosis. [ABSTRACT FROM AUTHOR]

This article comprehensively reviews current imaging concepts in spinal infection with primary focus on infectious spondylodiscitis (IS) as well as the less common entity of facet joint septic arthritis (FSA). This review encompasses the multimodality imaging appearances (radiographs, CT, MRI, and nuclear imaging) of spinal infection—both at initial presentation and during treatment—to aid the radiologist in guiding diagnosis and successful management. We discuss the pathophysiology of spinal infection in various patient populations (including the non-instrumented and postoperative spine) as well as the role of imaging-guided biopsy. We also highlight several non-infectious entities that can mimic IS (both clinically and radiologically) that should be considered during image interpretation to avoid misdiagnosis. These potential mimics include the following: Modic type 1 degenerative changes, acute Schmorl's node, neuropathic spondyloarthropathy, radiation osteitis, and inflammatory spondyloarthropathy (SAPHO syndrome). [ABSTRACT FROM AUTHOR]