Search

Objective: The objective of the study was to perform the control study between the electrocardiogram (ECG)-guided tip positioning and traditional radiological confirmation method in peripherally inserted central catheters (PICC) placement; the accuracy and applicability of ECG-guided tip positioning were investigated. It aimed to expand the scope of PICC applications.Methods: From March 2016 to August 2017, 101 cases of patient with tumor admitted to the hospital were included in this study. The control study was performed before and after PICC placement. The tip positioning of PICC placement was performed under the guidance of bedside ECG system. The X-ray confirmation was applied for confirmation. Several parameters were observed, including positioning accuracy, success rate of primary catheterization, incidence of ectopic catheter, average catheterization time, and incidence of complications.Results: Position accuracy was 100%. The success rate of primary catheterization was 99%. The incidence of ectopic catheter was 1%. Average catheterization time was (49.59 ± 21.45) min. Incidence of postoperative complications within 1 week was 4%.Conclusion: ECG-guided PICC tip positioning was safe and accurate. Success rate of catheterization could be improved. ECG-guided PICC tip positioning can be applied as an alternative approach for patients with P-wave fluctuations. [ABSTRACT FROM AUTHOR]

Purpose: To assess current practices in digital mammography (DM) in Portuguese healthcare providers using digital systems. To investigate compliance with European standards regarding mean glandular dose and quality control practice and to identify optimisation needs. Methods: Two questionnaires, targeted at breast radiographers and chief radiographers, were designed and applied in 65 imaging departments offering DM. Questions fielded were focused on the staff profile and technical/clinical practice. Results: Prior to starting their activity in DM, 70% (82 out of 118) of the respondents received training in DM. The practice in 29 out of 59 providers was established by the manufacturers' recommendations for image acquisition. Variations were observed between radiographers who belong to the same provider namely the selection of exposure parameters such as the target-filter combination and automatic mode. The use of the manual exposure mode was reported for imaging breast implants (44%) and surgical specimens (22%). The main causes of repeat examinations were skin folding (21%) and absence of pectoral muscle (PM) (20%). Conclusions: The study revealed opportunities to optimise radiographers' practice in DM regarding the selection of exposure parameters. A robust and consistent training programme in DM and established local protocols can help to reduce the variations observed and improve clinical practice. Main Messages: • Radiographers adopted different practices selecting AEC modes and T/F combinations. • Radiographer practice is more consistent using DR than using CR systems. • The main causes for rejecting images were the visibility of skin folding and PM absence. • Radiographers were partly unaware of the dose indicator. • Radiographers' training needs: QC, interventional procedures and breast dose optimisation. [ABSTRACT FROM AUTHOR]

Background: Upright head and neck position has been frequently applied as baseline for diagnosis of neck problems. However, the variance of the position after cervical motions has never been demonstrated. Thus, it is unclear if the baseline position varies evenly across the cervical joints. The purpose was to assess reposition errors of upright cervical spine.Methods: Cervical reposition errors were measured in twenty healthy subjects (6 females) using video-fluoroscopy. Two flexion movements were performed with a 20 s interval, the same was repeated for extension, with an interval of 5 min between flexion and extension movements. Cervical joint positions were assessed with anatomical landmarks and external markers in a Matlab program. Reposition errors were extracted in degrees (initial position minus reposition) as constant errors (CEs) and absolute errors (AEs).Results: Twelve of twenty-eight CEs (7 joints times 4 repositions) exceeded the minimal detectable change (MDC), while all AEs exceeded the MDC. Averaged AEs across the cervical joints were larger after 5 min' intervals compared to 20 s intervals (p < 0.05).Conclusions: This is the first study to demonstrate single joint reposition errors of the cervical spine. The cervical spine returns to the upright positions with a 2° average absolute difference after cervical flexion and extension movements in healthy adults. [ABSTRACT FROM AUTHOR]

Background: Radiographic imaging is a valuable tool in clinical practice for quick anatomical assessment. We aimed to radiographically assess (A) the anterior cruciate ligament (ACL) graft tunnel location after anatomic single-bundle (SB) reconstruction and (B) the effects of extremity positioning on the localization of the orifice of the tunnel in the distal femur in comparison with Blumensaat's line (BL). Methods: Three-dimensional computed tomography (3D CT) scan examinations of 22 knees of 22 subjects were evaluated. The 3D CT scan data was used to digitally reconstruct the true lateral radiographs. Graft tunnel location on the distal femoral shaft along the Blumensaat's line and perpendicular to it were assessed on these radiographs. The femur was digitally rotated to simulate varus, valgus, internal rotation and external rotation in 5-degree increments from 0 to 20-degree. At each incremental rotated position of the femur, position of the ACL graft tunnel was calculated relative to BL and the difference from the true lateral x-ray was estimated. Results: The position of the tunnel in the distal femur was 30.6 (±4.4) % along BL and 33.1 (±5.4) % perpendicular to BL. Ten and more degree of external, internal, valgus and varus rotations significantly affected the estimates of tunnel position (P < 0.05). Conclusions: Femoral tunnel location can be reliably estimated from lateral radiographs after anatomic SB ACL reconstruction. Although, ten or more degree of rotations can introduce significant inaccuracies in tunnel location estimates, our study suggests that BL is overall reliable for assessing location of the distal femoral tunnel. Level of evidence: Level 2b (Retrospective Cohort Study). [ABSTRACT FROM AUTHOR]

Background: Reference values and physiological measurements of intracranial pressure (ICP) are primarily reported in the supine position, while reports of ICP in the vertical position are surprisingly rare considering that humans maintain the vertical position for the majority of the day. In order to distinguish normal human physiology from disease entities such as idiopathic intracranial hypertension and normal pressure hydrocephalus, we investigated ICP in different body postures in both normal and ill subjects. Methods: Thirty-one patients were included: four normal patients following complete removal of a solitary clearly demarcated small brain tumour and fitted with a telemetric ICP monitoring device for long-term ICP monitoring; 27 patients requiring invasive ICP monitoring as a part of their diagnostic work-up or monitoring of shunt treatment effect. ICP was recorded in the following body positions: upright standing, sitting in a chair, supine and right lateral lumbar puncture position. Results: Linear regression of median ICP based on patient posture, group, and purpose of monitoring presented a significant model ( p < 0.001), but could not distinguish between patient groups ( p = 0.88). Regression of differences in median ICP between body postures and supine ICP as the baseline, presented a highly significant model ( p < 0.001) and adjusted R = 0.86. Both body posture ( p < 0.001) and patient group ( p < 0.001) were highly significant factors. Conclusions: Differences in ICP between body postures enabled us to distinguish the normal group from patient groups. Normal patients appear able to more tightly regulate ICP when switching body postures. [ABSTRACT FROM AUTHOR]

The highly programmable positioning of molecules (biomolecules, nanoparticles, nanobeads, nanocomposites materials) on surfaces has potential applications in the fields of biosensors, biomolecular electronics, and nanodevices. However, the conventional techniques including self-assembled monolayers fail to position the molecules on the nanometer scale to produce highly organized monolayers on the surface. The present article elaborates different techniques for the immobilization of the biomolecules on the surface to produce microarrays and their diagnostic applications. The advantages and the drawbacks of various methods are compared. This article also sheds light on the applications of the different technologies for the detection and discrimination of viral/bacterial genotypes and the detection of the biomarkers. A brief survey with 115 references covering the last 10 years on the biological applications of microarrays in various fields is also provided. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the frequency and severity of positioning errors in panoramic radiography in general dentistry. A total of 1904 digital panoramic radiographs, taken by the Public Dental Service in the county of Sörmland, Sweden, were analysed retrospectively. The study population consisted of all patients who underwent a panoramic examination during the year 2011. One experienced oral radiologist evaluated all radiographs for 10 common errors. Of the 1904 radiographs examined, 79 per cent had errors. The number of errors varied between 1-4 errors per image. No errors were found in 404 images (21%). Fifty-five images (3%) had severe errors, which made it impossible to make correct diagnostics. The most common error was the tongue not being in contact with the hard palate during exposure. However, this did not greatly affect the diagnostic usefulness of the image due to the ability to enhance the image.The patient's head was tilted too far upwards in 23 per cent of the images and the patient's head was rotated during exposure in 15 per cent. The least common error was due to patient movement during exposure (1%). Panoramic radiographs taken in general dental clinics in a Swedish county show several errors. Proper positioning of the patient is necessary to achieve panoramic images with good image quality. Some of the errors could be adjusted with the digital technique used.This allowed assessment of the images, which reduces radiation dose by avoiding retakes. [ABSTRACT FROM AUTHOR]

Professionals performing radiographic examinations are responsible for maintaining optimal image quality for accurate diagnoses. These professionals must competently execute techniques such as film manipulation and processing to minimize patient exposure to radiation. Improper performance by the professional and/or patient may result in a radiographic image of unsatisfactory quality that can also lead to a misdiagnosis and the development of an inadequate treatment plan. Currently, the most commonly performed extraoral examination is panoramic radiography. The invention of panoramic radiography has resulted in improvements in image quality with decreased exposure to radiation and at a low cost. However, this technique requires careful, accurate positioning of the patient's teeth and surrounding maxillofacial bone structure within the focal trough. Therefore, we reviewed the literature for the most common types of positioning errors in panoramic radiography to suggest the correct techniques. We would also discuss how to determine if the most common positioning errors occurred in panoramic radiography, such as in the positioning of the patient's head, tongue, chin, or body. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to evaluate the position of impacted mandibular third molars in different skeletal facial types among a group of Iranian patients. Materials and Methods: A total of 400 mandibular third molars in 200 subjects with different types of facial growth were radiographically investigated for their positions according to their types of facial growth on the basis of the β angle. The subjects were divided into three groups (class I, II, and III) according to ANB angle, representing the anteroposterior relationship of the maxilla to the mandible. Meanwhile, the subjects were also divided into three groups (long, normal, and short face) according to the angle between the stella-nasion and mandibular plane (SNGoGn angle). ANOVA was used for statistical analysis. Results: The mean β angle showed no significant difference among class I, II, and III malocclusions (df=2, F=0.669, p=0.513). The same results were also found in short, normal, and long faces (df=1.842, F=2, p=0.160). The mesioangular position was the most frequent one in almost all of the facial growth patterns. Distoangular and horizontal positions of impaction were not found in the subjects with class III and normal faces. In the long facial growth pattern, the frequency of vertical and distoangular positions were not different. Conclusion: In almost all of the skeletal facial types, the mesioangular impaction of the mandibular third molar was the most prevalent position, followed by the horizontal position. In addition, β angle showed no significant difference in different types of facial growth. [ABSTRACT FROM AUTHOR]

Pain and tenderness of the upper trapezius are the major complaints among people with chronic neck and shoulder disorders. Hyper-activation and increased muscle tension of the upper trapezius during arm elevation will cause imbalance of the scapular muscle force and contribute to neck and shoulder disorders. Assessing the elasticity of the upper trapezius in different arm positions is therefore important for identifying people at risk so as to give preventive programmes or for monitoring the effectiveness of the intervention programmes for these disorders. This study aimed to establish the reliability of supersonic shear imaging (SSI) in quantifying upper trapezius elasticity/shear elastic modulus and its ability to measure the modulation of muscle elasticity during arm elevation. Twenty-eight healthy adults (15 males, 13 females; mean age = 29.6 years) were recruited to participate in the study. In each participant, the shear elastic modulus of the upper trapezius while the arm was at rest and at 30° abduction was measured by two operators and twice by operator 1 with a time interval between the measurements. The results showed excellent within- and between-session intra-operator (ICC = 0.87–0.97) and inter-observer (ICC = 0.78–0.83) reliability for the upper trapezius elasticity with the arm at rest and at 30° abduction. An increase of 55.23% of shear elastic modulus from resting to 30° abduction was observed. Our findings demonstrate the possibilities for using SSI to quantify muscle elasticity and its potential role in delineating the modulation of upper trapezius elasticity, which is essential for future studies to compare the differences in shear elastic modulus between normal elasticity and that of individuals with neck and shoulder disorders. [ABSTRACT FROM AUTHOR]

Abstract: Volume visualization is a difficult three-dimensional task and a significant amount of research is devoted to the development of a suitable computer input device for it. Most of the proposed models use fixed displays, thus rendering extracted slices in orientations unrelated to their real locations within the volume. We present a new device which takes a different approach, as it leaves the volume in a fixed location and demands the user to change his or her posture to explore it from different angles. To implement this, we built a prototype based on a mobile display equipped with sensors that allows it to track its position, which is related to the location of the slice plane within the volume. Therefore, the user can manipulate this plane by displacing and rotating the display, which is a very intuitive method with minimum learning time. Furthermore, the postural changes required to use the device add a new channel of feedback, which effectively helps to reduce the cognitive load imposed on the user. We built a prototype device and tested it with two groups of volunteers who were asked to use it in a medical imaging application. Statistical analysis of the results shows that explorations made with the proposed device were considerably faster with no penalty in precision. We believe that, with further work, the proposed device can be developed into an useful tool for radiology and neurosurgery. [Copyright &y& Elsevier]

The deformity in idiopathic scoliosis (IS) is three dimensional in nature and effective correction involves all three planes. Even though the vertebral translation (VT) is an accepted element in the deformity along with vertebral rotation(VR) as reported by Asher and Cook (Spine (Phila Pa 1976) 20(12):1386-1391, ), Kotwicki et al. (Study Health Technol Inf 123:164-168, ) and Kotwicki and Napiontek (Pediatr Orthop 28(2):225-229, ), rib hump (rib hump index (RI)) and Cobb angle as reported by Aaro and Dahlborn (Spine (Phila Pa 1976) 6(6):567-572, ), it was assumed that VT was represented by adequately by Cobb angle and it was not analysed individually. We hypothesized that the Cobb angle and the VT measured in axial plane on CT scan and may not represent the same measurement and factors like coronal plane vertebral tilt,VR and vertebral deformation might affect them in different ways. Hence, VT should be considered as a separate variable and its relationship with VR, RI and Cobb angle should be investigated. Since the newer implants depend on curve translation and derotation for correction studying the role of VT and the relationships is important. VT, VR and RI were measured in CT scans of 75 patients with IS and correlated with Cobb angle. Regression analysis was used to identify the influence of the variables on each other. All the variables significantly correlated with one another but the correlation of Cobb and VT is not perfectly linear and it cannot be used to represent VT. VT influences RI much more than Cobb angle or VR. VT, therefore, merits further study treating it as an independent variable. [ABSTRACT FROM AUTHOR]

Objective: Superimposition of frontal cephalograms cannot be performed when the cephalograms are taken with different vertical head rotations. The purpose of the present study was to evaluate the validity of correcting the positional change of frontal cephalometric landmarks caused by vertical head rotation. Methods: In 30 adult individuals, frontal and lateral cephalograms were taken at a 90° angle. Geometric principles of radiography were used to calculate the possible vertical and horizontal landmark changes if the head should be rotated down 5° about an ear rod axis. The calculated changes were then compared with cephalometric changes measured on frontal cephalogram actually taken with the head rotated down 5°. Results: When the frontal cephalograms were taken with the head rotated down 5° about an ear rod axis, significant changes in the vertical position of the landmarks occurred, particularly in the landmarks located farther anteriorly from the ear rod axis. The comparison of calculated changes and real cephalometric changes showed that the differences were less than 0.4 mm in the vertical direction and less than 0.2 mm in the horizontal direction. The differences between calculated and real changes were smaller in the landmarks less affected by vertical head rotation. Conclusions: Even when frontal cephalograms are taken at different vertical head rotations, the concomitant changes in the position of the landmarks can be corrected through calculation using the geometric principle of radiography as long as frontal and lateral cephalograms are taken perpendicular to each other. (Korean J Orthod 2011;41(2):98-111) [ABSTRACT FROM AUTHOR]

The aim of this study is to describe the radiological changes in rib-vertebral angles (RVAs), rib-vertebral angle differences (RVADs), and rib-vertebral angle ratios (RVARas) in patients with untreated right thoracic adolescent idiopathic scoliosis and to compare with the normal subjects. The concave and convex RVA from T1 to T12, the RVADs and the RVARas were measured on AP digital radiographs of 44 female patients with right convex idiopathic scoliosis and 14 normal females. Patients were divided into three groups: normal subjects (group 1), scoliotic patients with Cobb's angle equal or <30° (group 2) and scoliotic patients with Cobb's angle over 30° (group 3). Overall values (mean ± SD) of the RVAs on the concave side were 90.5° ± 17° in group 1, 90.3° ± 15.8° in group 2 and 88.8° ± 15.4° in group 3. On the convex side, values were 90.0° ± 17.3° in group 1, 86.3° ± 13.7° in group 2 and 80.7° ± 14.4° in group 3. Overall values (mean ± SD) of the RVADs at all levels were 0.5° ± 0.7° in group 1, 4.0° ± 4.8° in group 2 and 8.0° ± 4.0° in group 3. The RVARa values (mean ± SD) at all levels was 1.008° ± 0.012° in group 1, 1.041° ± 0.061° in group 2 and 1.102° ± 0.151° in group 3. RVAD and RVARa values in the scoliotic segment were greater in patients with untreated scoliosis over 30° than in patients with an untreated deformity of <30° or normal subjects. A significant effect between groups was observed for the RVA, RVAD and RVARa variables. Measurement of RVA, RVAD and RVARa should not only be performed at and around the apex of a thoracic spinal deformity, but also extended to the whole thoracic spine. [ABSTRACT FROM AUTHOR]

The article offers guidelines for interpretation of chest radiographs of the critically ill patients in intensive care units (ICUs). Particular focus is given to cardiopulmonary disorders diagnosed through chest radiographs. The normal position of monitoring devices and other line placements, including the endotracheal tube, nasogastric tube and pulmonary capillary wedge pressure monitors, are described. The definitions and characterizations of cardiopulmonary disorders including pneumothorax, pneumomediastinum and pleural effusions are provided.

Abstract  We asked whether radiographic angles and signs of hip osteoarthrosis differ between radiographs of the pelvis taken in standing and supine positions. We retrospectively reviewed the radiographs of 61 patients (72 hips) with developmental dislocation of the hip. The minimum followup after closed reduction was 15 years (mean, 44 years; range, 15–64 years). We used pelvic radiographs in supine and standing positions taken at the same time and determined the following parameters: minimal joint space width, acetabular roof obliquity (AC angle), depth of the acetabulum (ACM angle), and center-edge angle. Osteoarthrosis was assessed according to Kellgren and Lawrence. Two independent observers measured all radiographs manually with a goniometer. AC angle, center-edge angle, and minimum joint space width differed between the radiographs taken in supine and standing positions at followup, whereas osteoarthrosis grading and the ACM angle did not. The AC angle depended on patient position and predicted development of osteoarthrosis. The minimum joint space width was influenced by the radiographic position with greater values in the supine position. ACM angle and the osteoarthrosis grade according to Kellgren and Lawrence were unaffected by the patient’s position. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The present paper illustrates our attempt to design and test the reproducibility of low-cost patient positioning devices prepared in-house in our radiotherapy department. Rigid thermocole boards with angulations, scales and support were designed as breast, pelvis and head positioning devices. Reproducibility and accuracy were tested by serial electronic portal imaging detector imaging. The positioning devices (with or without superimposed moulds) showed variations within 2-3 mm on serial treatment days which were within acceptable limits. It is therefore concluded that low-cost patient positioning devices for head, breast and pelvis (the common sites of treatments in radiotherapy) can be fabricated from available materials in-house. These have been shown to be resulting in accurate immobilization, can be customized for particular techniques and are considerably cheaper than commercially available solutions. [ABSTRACT FROM AUTHOR]

Rationale: Superimposition of the rims of the medial tibial plateau to within 1mm is an aim of fluoroscopic knee positioning protocols for osteoarthritic (OA) knee radiography and has also been proposed as a measure of quality for non-fluoroscopic methods.Objective: To evaluate the effect of tibial rim alignment (TRA) on reproducibility of joint space width (JSW) measurement, both were measured from radiographs taken with each tibial plateau at a range of angles determined by different non-fluoroscopic views.Methods: TRA and JSW measurements were taken from both knees of 100 OA patients each radiographed in fully extended, schuss/tunnel, and MTP views. Degree of TRA was compared with JSW reproducibility using correlation, and between groups defined both by the 1mm threshold and by TRA-defined quartiles.Results: JSW reproducibility was dependent on the degree of TRA in the fully extended and schuss/tunnel flexed knee views, although the use of the specific TRA threshold of 1mm was not supported. In the MTP view, JSW measurement was found to be highly reproducible across the full range of TRA values.Conclusion: These results contradict claims that TRA to within 1mm is essential for useful measurement of JSW. It is an arbitrary threshold, of use in quality control (QC) for protocols which explicitly require such alignment, and the choice of QC criteria for other protocols should be evaluated on a view-by-view basis. The results confirm previous studies showing the MTP view to afford highly reproducible JSW measurement. [ABSTRACT FROM AUTHOR]

Background and purpose It is unclear whether osteoarthritis (OA) of the knee is seen better in standing flexion position radiographs than in the standing extended view. We assessed the value of standing flexion views. Patients and methods We retrospectively evaluated 1,090 radiographs of 545 consecutive knees with non-traumatic knee pain, comparing standing fixed flexion view (FFV) and standing extended view (SEV). OA was classified according to the Kellgren-Lawrence (KL) radiographic grading scale and joint space widths were measured. Results Medial joint space width was lower on average in the FFV, with the greatest difference in KL II knees. Medial full-thickness loss of cartilage was also seen more often in the FFVs of knees with moderate OA (KL II–III) than in the SEVs (6% vs. 19%). Interpretation Using FFV, there is no need to measure the exact knee flexion angle to use fluoroscopy. In earlier studies, the FFV has been found to be reproducible and easy to use in clinical practice. We recommend using flexion views when deciding the appropriate type of intervention in patients with OA. Full-thickness loss of cartilage in particular is better seen in the flexion view, which may be helpful if planning unicompartmental knee arthroplasty. [ABSTRACT FROM AUTHOR]

An abstract of the article "Persistent occipito-posterior position: outcomes following digital rotation. A pilot study," by K. Graham, H. Phipps, J. Hyett, J. Ludlow, A. Mackie, A. Marren and B. deVries is presented.