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Background: Lumbosacral transitional vertebrae (LSTV) or lumbarization of sacral vertebrae and sacralization of lumbar vertebrae are congenital variations. These are associated with alterations in anatomy and biomechanics of spinal and paraspinal structures, which lead to low back pain (LBP). Aims and Objectives: This radiological study was designed to identify the prevalence of LSTV in patients presenting with LBP and to classify the anatomical variations in LSTV according to the Castellvi classification. Materials and Methods: This hospital-based, cross-sectional, observational cohort study was conducted in the Department of Radiodiagnosis, in different medical colleges and hospitals of West Bengal. The study was done on 1500 patients aged 20-75 years with a history of LBP. Antero-posterior and lateral lumbosacral radiographs were done to identify LSTV. Results: The present study in West Bengal shows that 24.1% of subjects had LSTV among LBP patients, Castellvi Type IIA (33.4%) being the most common anatomical variant, followed by Type IB (19.6%). Sacralization (22.3%) was found more common than lumbarization (1.8%). Conclusion: LSTV comprises almost one-fourth of cases of low back ache which can be easily diagnosed by simple radiograph. It has important implications for surgery in the lumbosacral region. [ABSTRACT FROM AUTHOR]

Background: The iconic freshwater cichlid fishes (Cichlidae) comprise about 1750 validly named species and hundreds more that are known, but not yet described and named. Cichlids are an important source of protein for millions of people on several continents, are model organisms in studies of evolution, speciation, ecology, development, behaviour and physiology and are popular as aquarium fishes. Yet, comparative studies of cichlid internal anatomy are rare. Even their osteology has not been taxonomically surveyed. The cichlid postcranial skeleton has been especially neglected. New information: Here, I provide the first survey in cichlids of the considerable variation in numbers of vertebrae, supraneurals and dorsal- and anal-fin supports (pterygiophores), as well as the patterns with which the pterygiophores insert between the neural or haemal spines. The study includes some 1700 specimens of nearly 400 cichlid species. Focusing on the largest subfamily, the African cichlids or Pseudocrenilabrinae, the survey furnishes data from species in all but one of its 166 genera. Limited data from species in the other cichlid subfamilies (Etroplinae, Ptychochrominae and Cichlinae) and from the related leaffishes, Polycentridae, are also presented. Key examples of pterygiophore insertion patterns from throughout the range of variation are illustrated and discussed. Detailed analytical tables and all raw data are provided in supplementary files. A bizarre specialisation in Cyprichromis is noted, evidently for the first time. Uniquely in this Lake Tanganyikan genus, five to seven anal pterygiophores are abdominal in position, located anterior to the anal fin and inserting toward or between successive pairs of pleural ribs. Taxonomic changes: The most speciose tribe of African cichlids, currently known as Haplochromini, is correctly called Pseudocrenilabrini. Based chiefly on the molecular phylogenetic findings of other workers, I propose four pseudocrenilabrine subtribes, one occurring in rivers and three endemic to Lake Malawi. I also re-assign the Lake Tanganyikan tribe Tropheini as another subtribe of Pseudocrenilabrini, in line with numerous molecular studies placing tropheines firmly within this tribe. The remaining genera of Pseudocrenilabrini remain incertae sedis in this tribe pending clarification of their phylogenetic relationships. The character complex here surveyed is a promising source of taxonomically and phylogenetically informative characteristics distinguishing or uniting cichlid taxa at multiple hierarchical levels, from species through subfamily. This reference set of novel character data can also provide information for palaeontological studies of African cichlids. These attributes are skeletal features potentially available for study in well preserved fossils and may help determine their correct taxonomic placement. [ABSTRACT FROM AUTHOR]

Background: Lumbosacral transitional vertebrae (LSTV) or lumbarization of sacral vertebrae and sacralization of lumbar vertebrae are congenital variations. These are associated with alterations in anatomy and biomechanics of spinal and paraspinal structures, which lead to low back pain (LBP). Aims and Objectives: This radiological study was designed to identify the prevalence of LSTV in patients presenting with LBP and to classify the anatomical variations in LSTV according to the Castellvi classification. Materials and Methods: This hospital-based, cross-sectional, observational cohort study was conducted in the Department of Radiodiagnosis, in different medical colleges and hospitals of West Bengal. The study was done on 1500 patients aged 20–75 years with a history of LBP. Antero-posterior and lateral lumbosacral radiographs were done to identify LSTV. Results: The present study in West Bengal shows that 24.1% of subjects had LSTV among LBP patients, Castellvi Type IIA (33.4%) being the most common anatomical variant, followed by Type IB (19.6%). Sacralization (22.3%) was found more common than lumbarization (1.8%). Conclusion: LSTV comprises almost one-fourth of cases of low back ache which can be easily diagnosed by simple radiograph. It has important implications for surgery in the lumbosacral region.

Preiser's disease or idiopathic avascular necrosis of the scaphoid is a rare condition where ischemia and necrosis of the scaphoid bone occurs without previous fracture. It is thought to be caused by repetitive micro trauma or side effects of drugs (e.g., steroids or chemotherapy) in conjunction with existing defective vascular supply to the proximal pole of the scaphoid. Wrist radiography or CT coupled with MRI is the imaging modality of choice in the diagnosis of this rare entity.Here, we report a case of Preiser's disease of the left wrist in a 17-year-old female patient who presented with left wrist pain of 2 years duration in the absence of trauma history or causative drug use. The diagnosis was made by wrist X-ray and MRI. She was managed by Physiotherapy and wrist immobilization using wrist and forearm support as well as NSAIDS (Meloxicam).

Background: Few longitudinal studies exist comparing medical procedures after football injuries on artificial and natural grass surfaces. Purpose/Hypothesis: The purpose of this study was to specifically compare imaging and surgical procedures after surface-related collegiate football injuries on artificial turf versus natural grass. It was hypothesized that there would be no difference in the incidence of imaging and surgical procedures, combined medical procedures, or combined substantial and severe injuries over time between these surfaces. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 39 universities across all Football Bowl Subdivision conferences were evaluated over 15 seasons (2006-2020). Playing surfaces evaluated were either a heavyweight artificial turf infill system (≥9.0 lb infill/ft2) or natural grass. Outcomes of interest included medical procedures across injury category, primary injury type, injury location, and specific procedures. Data involved multivariate analyses of variance (MANOVA) and Wilks λ criteria using general linear model procedures and were expressed as medical procedure incidence rates (IRs) per 10-game season. Results: Overall, 2224 games were documented: 1106 (49.7%) on artificial turf and 1118 (50.3%) on natural grass. Of the 9137 total injuries reported, 4010 (44%) were surface-related cases. MANOVA indicated significant main effects between surfaces according to imaging procedure (F 2,1738 = 4.718; P =.009), surgical procedure (F 1,539 = 5.974; P =.003), and medical diagnosis (F 2,456 = 2.643; P =.040). Post hoc analyses indicated significantly lower (P <.05) incidences on artificial turf versus natural grass, respectively, for the following outcomes: imaging procedures ordered after player-to-surface impact trauma (IR [95% CI], 1.5 [1.3-1.8] vs 2.1 [1.9-2.4]), shoe-to-surface trauma during physical contact (4.4 [4.1-4.7] vs 5.2 [4.9-5.5]), foot injuries (0.6 [0.5-0.7] vs 1.1 [0.9-1.2]), ligament sprains/tears (4.6 [4.3-4.9] vs 5.3 [5.0-5.6]), muscle strains/tears (0.2 [0.2-0.3] vs 0.7 [0.6-0.9]), surgeries performed after shoe-to-surface trauma during physical contact (1.1 [0.9-1.3] vs 1.6 [1.4-1.8]), lower body surgeries (1.8 [1.6-2.0] vs 2.3 [2.1-2.6]), and surgeries involving ligament tears (1.0 [0.9-1.2] vs 1.5 [1.3-1.7]), as well as fewer diagnoses of syndesmosis sprains/tears (0.7 [0.5-0.8] vs 1.0 [0.8-1.2]) and Lisfranc trauma (0.3 [0.2-0.4] vs 0.5 [0.4-0.7]). Trends over the 15 seasons indicated a significant rise in combined medical procedures (P =.005) and combined substantial and severe injuries (P =.0007) irrespective of surface. Conclusion: Results indicated that collegiate football competition on heavyweight artificial turf resulted in lower incidences of imaging and surgical procedures and medical diagnoses compared with natural grass. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (OA) affects over 650 million patients worldwide. Total knee replacement is aimed at end-stage OA to relieve symptoms of pain, stiffness and reduced mobility. However, the role of imaging modalities in monitoring symptomatic disease progression remains unclear. This study aimed to compare machine learning (ML) models, with and without imaging features, in predicting the two-year Western Ontario and McMaster Universities Arthritis Index (WOMAC) score for knee OA patients. We included 2408 patients from the Osteoarthritis Initiative (OAI) database, with 629 patients from the Multicenter Osteoarthritis Study (MOST) database. The clinical dataset included 18 clinical features, while the imaging dataset contained an additional 10 imaging features. Minimal Clinically Important Difference (MCID) was set to 24, reflecting meaningful physical impairment. Clinical and imaging dataset models produced similar area under curve (AUC) scores, highlighting low differences in performance AUC < 0.025). For both clinical and imaging datasets, Gradient Boosting Machine (GBM) models performed the best in the external validation, with a clinically acceptable AUC of 0.734 (95% CI 0.687–0.781) and 0.747 (95% CI 0.701–0.792), respectively. The five features identified included educational background, family history of osteoarthritis, co-morbidities, use of osteoporosis medications and previous knee procedures. This is the first study to demonstrate that ML models achieve comparable performance with and without imaging features. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the utility of the proximal femur in the forensic age estimation by assessing changes in bone densities through radiographs. Using Otsu's threshold, bone density was quantified by counting all white pixel values within selected regions of interest, which include femoral head (FH), femoral neck (FN), Ward's triangle (WT), and greater trochanter (GT) from 354 left femora of Northern Thai descent. The pixel width of medullary cavity (MC) was also estimated. Furthermore, the study evaluated the performance of linear regression (LR) models for age estimation from radiographic images of proximal femora. Negative correlations were observed between FH, FN, WT, and GT pixel intensity with the age-at-death of the samples, with females exhibiting stronger correlations than males. Moreover, a positive correlation was found between age and MC width in female samples, while male MC widths did not show any relationship with increasing age. The results showed a slight difference between the LR model applied to both sexes, which integrated all variables, and the alternative configuration that only utilized relevant attributes. Both models exhibited similar performance, with a narrow range of root mean square error (RMSE) values, ranging from 12.67 to 12.71 years, and a correlation coefficient range of 0.51 to 0.52. For females, the LR model with FN and WT as selected attributes (RMSE = 11.85 years, correlation coefficient = 0.65) performed decently, while for males, the LR model with all variables showed RMSE of 12.52 years and correlation coefficient of 0.46. This study showcased the potential application of pixel intensity in predicting age. [ABSTRACT FROM AUTHOR]

There are concerns as to the reliability of proximal humerus radiographic measurements, particularly regarding the rotational position of the humerus when obtaining radiographs. Twenty-four patients with proximal humerus fractures fixed surgically with locked plates received postoperative anteroposterior radiographs with the humerus in neutral rotation and in 30° of internal and external rotation. Radiographic measurements for head shaft angle, humeral offset and humeral head height were performed in each humeral rotation position. Intra-class correlation coefficient was used to assess inter-rater and intra-rater reliability. Mean differences (md) in measurements between humeral positions was evaluated using one-way ANOVA. Head shaft angle demonstrated good-to-excellent reliability; the highest estimates for inter-rater reliability (ICC: 0.85; 95% CI: 0.76, 0.94) and intra-rater reliability (ICC: 0.96; 95% CI: 0.93, 0.98) were achieved in neutral rotation. There were significant differences in measurement values between each rotational position, with mean head shaft angle of 133.1° in external rotation, and increasingly valgus measurements in neutral (md: 7.6°; 95% CI: 5.0, 10.3°; p < 0.001) and internal rotation (md: 26.4°; 95% CI: 21.8, 30.9°; p < 0.001). Humeral head height and humeral offset showed good-to-excellent reliability in neutral and external rotation, but poor inter-rater reliability in internal rotation. Humeral head height was significantly greater using internal compared to external rotation (md: 4.5 mm; 95% CI: 1.7, 7.3 mm; p = 0.002). Humeral offset was significantly greater in external compared to internal rotation (md: 4.6 mm; 95% CI: 2.6, 6.6 mm; p < 0.001). Views of the humerus in neutral rotation and 30° of external rotation displayed superior reliability. Differences in radiographic measurement values, depending on humeral rotation views, can make for problematic correlations with patient outcome measures. Studies assessing radiographic outcomes following proximal humerus fractures should ensure standardized humeral rotation for obtaining anteroposterior shoulder radiographs, with neutral rotation and external rotation views likely yielding the most reliable results. Level IV [ABSTRACT FROM AUTHOR]

BACKGROUND: Robotic assistance has been shown to increase instrumentation placement accuracy in open and minimally invasive spinal fusion. These gains have been achieved without increases in operative times, blood loss, or hospitalization duration. However, most work has been done in the degenerative population and little is known of the utility of robotic assistance when applied to spinal trauma. This is largely due to the uncertainty stemming from the disruption of normal anatomy by the traumatic injury. Since the robot depends upon registration for instrumentation guidance according to the fiducials it uses, trauma can introduce unique challenges. The present study sought to evaluate the safety and efficacy of robotic assistance in a consecutive cohort of spine trauma patients. METHODS: All patients with Thoracolumbar Injury Classification and Severity Scale (TLICS) >4 who underwent robot-assisted spinal fusion using the Globus ExcelsiusGPS at a single tertiary care center for trauma between 2020 and 2022 were identified. Demographic, clinical, and surgical data were collected and analyzed; the primary endpoints were operative time, fluoroscopy time, estimated blood loss, postoperative complications, admission time, and 90-day readmission rate. The paired t-test was used to compare differences between mean values when looking at the number of surgical levels. RESULTS: Forty-two patients undergoing robot-assisted spinal surgery were included (mean age 61.3±17.1 year; 47% female. Patients were stratified by the number of operative levels, 2 (n = 10), 3-4 (n = 11), 5 to 6 (n = 13), or >6 (n = 8). There appeared to be a positive correlation between number of levels instrumented and odds of postoperative complications, admission duration, fluoroscopy time, and estimated blood loss. There were no instances of screw malposition or breach. CONCLUSIONS: This initial experience suggests robotic assistance can be safely employed in the spine trauma population. Additional experiences in larger patient populations are necessary to delineate those traumatic pathologies most amenable to robotic assistance.

Background. Fluoroscopy is the standard intraoperative imaging in orthopaedic surgery. Real-time visualization of fracture reduction and implant placement is essential, especially during closed reduction and percutaneous pin (CRPP) fixation. In the absence of fluoroscopy, conventional radiographs are used. Objective. This study evaluated the early functional outcomes of CRPP fixation for proximal phalangeal and metacarpal fractures done under conventional radiograph guidance. Methodology. Fifty-four patients with 72 fractures of the metacarpal or proximal phalanx in 70 fingers underwent CRPP fixation at the emergency room. Radiographs were used to assess reduction and fixation. Primary outcome measures were Total Active Motion (TAM), and Disabilities of the Arm, Shoulder, and Hand (DASH) score, while secondary outcome measures included fracture reduction, union rate, and complications. These were all evaluated at a mean of 12 weeks after surgery. Results. An average of 2.9 radiographs were taken for each fracture, with a mean surgical time of 40 minutes. The TAM was “excellent to good” in 47% of fingers (mean = 258°), while the rest had “fair” scores (mean = 235°). Seventy-six percent of patients had a mean DASH score of 4.9. Thirty-five percent of fractures achieved anatomic reduction and maintained until union. Short procedure time did not influence the DASH scores. Complications reported were malunion (2), stiffness (5), and extension lag (7). There was no reported nonunion. Conclusion. Closed reduction with pinning of proximal phalangeal and metacarpal fractures guided by conventional radiograph in the absence of fluoroscopy, remains to be effective and reliable with favorable early outcomes.

BACKGROUND: The volume of medical diagnostic studies continues to increase annually, intensifying the desire to implement advanced technologies in the field of medical diagnostics. One of the promising approaches that has attracted attention is the use of artificial intelligence in this area. A study was conducted on the automated analysis of chest radiographs using the AI service PhthisisBioMed at a city hospital specializing in the treatment of respiratory diseases. AIM: The study aimed to assess the diagnostic accuracy of the artificial intelligence service “PhthisisBioMed” for the detection of respiratory pathologies in the context of a city hospital that provides 24-hour specialized care in the field of pulmonology. MATERIALS AND METHODS: This study employed a prospective design, with the results of the artificial intelligence service available to the physician on request. This enabled the physician to review the results of the service if an alternative opinion was needed. The reference test was conducted by radiologists at Samara City Hospital No. 4, who described the examinations performed during the testing period. The index test was performed on the software “Program for Automated Analysis of Digital Chest Radiographs/Fluorograms according to TU 62.01.29-001-96876180-2019” produced by PhthisisBioMed LLC. The PhthisisBioMed software was employed to analyze digital fluorograms of the lungs in direct anterior projection. The software automatically identified the following radiological signs of pathologies: pleural effusion, pneumothorax, atelectasis, darkening, infiltration/consolidation, dissemination, cavity, calcification/calcified shadow, and cortical layer integrity violation. Fluorograms of patients over the age of 18 were included in the analysis. The study was conducted within the framework of research and development work No. 121051700033-3, entitled “Lung Damage of Infectious Etiology. Improvement of Methods of Detection, Diagnosis and Treatment” (14.05.2021). RESULTS: Following the pilot operation of the PhthisisBioMed artificial intelligence service and subsequent ROC analysis, the diagnostic accuracy metrics claimed by the manufacturer of the artificial intelligence medical device were confirmed. The service provided the probability of the presence of various pathologies. According to the highlighted labels, 63 patients (4.8%) were suspected of tuberculosis based on characteristic radiologic features. The conclusion was made independently by the radiologist, and the results were evaluated by the attending physician. The attending physician had the opportunity to compare the results and discuss them with the radiologist if differences were found. The results of the survey of pulmonologists who participated in the study indicated that the conclusion of the artificial intelligence service was received automatically within 15 seconds, while the conclusion of the physician was received within 30 minutes or more. CONCLUSIONS: The results of the study indicate that the implementation of the PhthisisBioMed software is expedient both in the outpatient department of the hospital in terms of assessing the annual fluorographic examination of the population, and in the pulmonology service of the city, inpatient and admission department of the hospital.

Abstract Objectives To establish a radiomics-based automatic grading model for knee osteoarthritis (OA) and evaluate the influence of different body positions on the model’s effectiveness. Materials and methods Plain radiographs of a total of 473 pairs of knee joints from 473 patients (May 2020 to July 2021) were retrospectively analyzed. Each knee joint included anteroposterior (AP) and lateral (LAT) images which were randomly assigned to the training cohort and the testing cohort at a ratio of 7:3. First, an assessment of knee OA severity was done by two independent radiologists with Kallgren–Lawrence grading scale. Then, another two radiologists independently delineated the region of interest for radiomic feature extraction and selection. The radiomic classification features were dimensionally reduced and a machine model was conducted using logistic regression (LR). Finally, the classification efficiency of the model was evaluated using receiver operating characteristic curves and the area under the curve (AUC). Results The AUC (macro/micro) of the model using a combination of AP and LAT (AP&LAT) images were 0.772/0.778, 0.818/0.799, and 0.864/0.879, respectively. The radiomic features from the combined images achieved better classification performance than the individual position image (p

Objective: To identify the potential factors that induce procedural errors during posterior proximal resin composite restorations placed by dental students. Materials and Methods: This retrospective study evaluated 803 bitewing radiographs of posterior proximal resin composite restorations placed by dental students at Imam Abdulrahman bin Faisal University. Atypical radiographic signs of failure were screened, and different patient-, operator-, and clinical-related factors were recorded. Chi-square test was used to examine the relationship between procedural errors and recorded factors. Stepwise adjusted logistic regression model was performed to identify predictors of procedural errors. Results: The most observed errors were internal gaps at the bonding interface and internal voids. Molars had 0.39 the risk of internal voids (odds ratio [OR] = 0.39; confidence interval [CI] = 0.25–0.60; P = 40 years of age had 1.79 the risk of overhang compared to younger patients (OR = 1.79; CI = 1.04–3.11; P =

Abstract Background Unwarranted temporal and geographical variations are acknowledged as a profound problem for equal access and justice in the provision of health services. Even more, they challenge the quality, safety, and efficiency of such services. This is highly relevant for imaging services. Objective To analyse the temporal and geographical variation in the number of diagnostic images in Norway from 2013 to 2021. Methods Data on outpatient imaging provided by the Norwegian Health Economics Administration (HELFO) and inpatient data afforded by fourteen hospital trusts and hospitals in Norway. Data include the total number of imaging examinations according to the Norwegian Classification of Radiological Procedures (NCRP). Analyses were performed with descriptive statistics. Results More than 37 million examinations were performed in Norway during 2013–2021 giving an average of 4.2 million examinations per year. In 2021 there was performed and average of 0.8 examinations per person and 2.2 examinations per person for the age group > 80. There was a 9% increase in the total number of examinations from 2013 to 2015 and a small and stable decrease of 0.5% per year from 2015 to 2021 (with the exception of 2020 due to the pandemic). On average 71% of all examinations were outpatient examinations and 32% were conducted at private imaging centres. There were substantial variations between the health regions, with Region South-East having 53.1% more examinations per inhabitant than Region West. The geographical variation was even more outspoken when comparing catchment areas, where Oslo University Hospital Trust had twice as many examinations per inhabitant than Finnmark Hospital Trust. Conclusion As the population in Norway is homogeneous it is difficult to attribute the variations to socio-economic or demographic factors. Unwarranted and supply-sensitive variations are challenging for healthcare systems where equal access and justice traditionally are core values.

Coxofemoral luxation or hip joint luxation is the most commonly occurring injury in dogs and cats. There are different methods in treating this case with different outcomes, toggle pin stabilization technique is one of them. This study aimed to evaluate metal suture with fabricated toggle pin as prosthetic round ligament (teres ligament) for the treatment of hip joint luxation in dogs. The experimental study was conducted of five adult mongrel dogs induced coxofemoral luxation (hip luxation) under general anesthesia, then the induced luxation was reduced by using a fabricated toggle pin from a Steinman pin with metal suture passed through a femero-acetabular tunnel created by electrical drill started from third trochanter and exits at the acetabular fossa passing through the fovea capitis. All experimental animals were followed up clinically for six weeks at two intervals (day 14th, and day 42nd), and radiologically for six weeks at three intervals at day zero, day 28th, and day 42nd. All experimental animals were bearing weight on the affected limb the next day after surgery. The lameness score of all cases was 0/5 representing normal gait at both two- and six-week intervals. The radiological results showed a good reduction in luxated limb along the period of the study. In conclusion, a fabricated toggle pin with metal suture is a good stabilizer for hip luxation cases and provides a rigid fixation for the joint.

Objectives: To establish a radiomics-based automatic grading model for knee osteoarthritis (OA) and evaluate the influence of different body positions on the model's effectiveness. Materials and methods: Plain radiographs of a total of 473 pairs of knee joints from 473 patients (May 2020 to July 2021) were retrospectively analyzed. Each knee joint included anteroposterior (AP) and lateral (LAT) images which were randomly assigned to the training cohort and the testing cohort at a ratio of 7:3. First, an assessment of knee OA severity was done by two independent radiologists with Kallgren–Lawrence grading scale. Then, another two radiologists independently delineated the region of interest for radiomic feature extraction and selection. The radiomic classification features were dimensionally reduced and a machine model was conducted using logistic regression (LR). Finally, the classification efficiency of the model was evaluated using receiver operating characteristic curves and the area under the curve (AUC). Results: The AUC (macro/micro) of the model using a combination of AP and LAT (AP&LAT) images were 0.772/0.778, 0.818/0.799, and 0.864/0.879, respectively. The radiomic features from the combined images achieved better classification performance than the individual position image (p < 0.05). The overall accuracy of the radiomic model with AP&LAT images was 0.727 compared to 0.712 and 0.417 for radiologists with 4 years and 2 years of musculoskeletal diagnostic experience. Conclusions: A radiomic model constructed by combining the AP&LAT images of the knee joint can better grade knee OA and assist clinicians in accurate diagnosis and treatment. Critical relevance statement: A radiomic model based on plain radiographs accurately grades knee OA severity. By utilizing the LR classifier and combining AP&LAT images, it improves accuracy and consistency in grading, aiding clinical decision-making, and treatment planning. Key Points: Radiomic model performed more accurately in K/L grading of knee OA than junior radiologists. Radiomic features from the combined images achieved better classification performance than the individual position image. A radiomic model can improve the grading of knee OA and assist in diagnosis and treatment. [ABSTRACT FROM AUTHOR]

(1) Objective: In this study, a regression-based multi-modal deep learning model was developed for use in bone age assessment (BAA) utilizing hand radiographic images and clinical data, including patient gender and chronological age, as input data. (2) Methods: A dataset of hand radiographic images from 2974 pediatric patients was used to develop a regression-based multi-modal BAA model. This model integrates hand radiographs using EfficientNetV2S convolutional neural networks (CNNs) and clinical data (gender and chronological age) processed by a simple deep neural network (DNN). This approach enhances the model's robustness and diagnostic precision, addressing challenges related to imbalanced data distribution and limited sample sizes. (3) Results: The model exhibited good performance on BAA, with an overall mean absolute error (MAE) of 0.410, root mean square error (RMSE) of 0.637, and accuracy of 91.1%. Subgroup analysis revealed higher accuracy in females ≤ 11 years (MAE: 0.267, RMSE: 0.453, accuracy: 95.0%) and >11 years (MAE: 0.402, RMSE: 0.634, accuracy 92.4%) compared to males ≤ 13 years (MAE: 0.665, RMSE: 0.912, accuracy: 79.7%) and >13 years (MAE: 0.647, RMSE: 1.302, accuracy: 84.6%). (4) Conclusion: This model showed a generally good performance on BAA, showing a better performance in female pediatrics compared to male pediatrics and an especially robust performance in female pediatrics ≤ 11 years. [ABSTRACT FROM AUTHOR]

Chest radiographs provide vital information to clinicians. Medical professionals need to be proficient in interpreting chest radiographs to care for patients. This review examines online methods for teaching chest radiograph interpretation to non-radiologists. An online database search of PubMed and the Cochrane Databases of Systematic Reviews revealed 25 potential evidence sources. After using the similar articles tool on PubMed, eight evidence sources met the inclusion criteria. Three sources supported the use of online learning to increase students' confidence regarding chest radiograph interpretation. The evidence suggests that through self-directed online learning, students can learn skills to diagnose disease processes as well as to confirm the placement of invasive lines and tubes. Using online learning for teaching radiograph interpretation to non-radiologists is an evolving practice. A flexible schedule is needed when implementing the electronic learning process for busy students. Monitoring module completion and postlearning assessment of knowledge is important. Further research is warranted on electronic teaching of chest radiograph interpretation in nurse anesthesia programs. A list of potential online resources for teaching chest radiograph interpretation is presented. [ABSTRACT FROM AUTHOR]

OBJECTIVE The inclusion of vertebral heart score (VHS) and, more recently, the inclusion of the vertebral left atrial size (VLAS) in radiographic evaluation have become important screening tools for identifying dogs with occult cardiac disease. Several recent papers have shown there are interbreed variations in the VHS reference range. Our hypothesis is that the Miniature Schnauzer would also have a higher reference range for its VHS. ANIMALS The electronic medical records of IDEXX Telemedicine Consultants were searched for Miniature Schnauzers undergoing thoracic radiographs between March 1, 2022, and February 28, 2023. METHODS Dogs were included if they had 3 view thoracic radiographs performed and no evidence of cardiopulmonary disease was detected. Dogs with incomplete radiographic studies or cardiac or extracardiac disease were excluded. The VHS and VLAS measurements were performed by 2 board-certified cardiologists independent of one another. RESULTS A total of 1,000 radiographs were obtained of which 272 were included for the study. The overall range for the VHS in this cohort was 9.68 to 12.07 with a median of 10.9. For VLAS measurements, a range of 1.71 to 2.4 was documented with a median of 2.0. CLINICAL RELEVANCE The VHS for Miniature Schnauzers without cardiac disease was confirmed to be higher than the canine reference range. [ABSTRACT FROM AUTHOR]

Background: Unwarranted temporal and geographical variations are acknowledged as a profound problem for equal access and justice in the provision of health services. Even more, they challenge the quality, safety, and efficiency of such services. This is highly relevant for imaging services. Objective: To analyse the temporal and geographical variation in the number of diagnostic images in Norway from 2013 to 2021. Methods: Data on outpatient imaging provided by the Norwegian Health Economics Administration (HELFO) and inpatient data afforded by fourteen hospital trusts and hospitals in Norway. Data include the total number of imaging examinations according to the Norwegian Classification of Radiological Procedures (NCRP). Analyses were performed with descriptive statistics. Results: More than 37 million examinations were performed in Norway during 2013–2021 giving an average of 4.2 million examinations per year. In 2021 there was performed and average of 0.8 examinations per person and 2.2 examinations per person for the age group > 80. There was a 9% increase in the total number of examinations from 2013 to 2015 and a small and stable decrease of 0.5% per year from 2015 to 2021 (with the exception of 2020 due to the pandemic). On average 71% of all examinations were outpatient examinations and 32% were conducted at private imaging centres. There were substantial variations between the health regions, with Region South-East having 53.1% more examinations per inhabitant than Region West. The geographical variation was even more outspoken when comparing catchment areas, where Oslo University Hospital Trust had twice as many examinations per inhabitant than Finnmark Hospital Trust. Conclusion: As the population in Norway is homogeneous it is difficult to attribute the variations to socio-economic or demographic factors. Unwarranted and supply-sensitive variations are challenging for healthcare systems where equal access and justice traditionally are core values. [ABSTRACT FROM AUTHOR]

• Bitewing radiographs for proximal resin composite restorations performed by dental students were assessed for different procedural errors. • The most observed procedural errors were internal gaps at the bonding interface and internal voids. • Molars had 0.39 the risk of internal voids, 0.41 the risk of sharp angle, and 0.57 the risk of open contact compared to premolars. • This study reinforces the conclusions drawn from previous articles, which indicate a strong correlation between dental students and procedural errors in proximal resin composite restorations. • Dental schools may consider adopting new tools and approaches to teach proximal resin composite restoration placement effectively. To identify the potential factors that induce procedural errors during posterior proximal resin composite restorations placed by dental students. This retrospective study evaluated 803 bitewing radiographs of posterior proximal resin composite restorations placed by dental students at Imam Abdulrahman bin Faisal University. Atypical radiographic signs of failure were screened, and different patient-, operator-, and clinical-related factors were recorded. Chi-square test was used to examine the relationship between procedural errors and recorded factors. Stepwise adjusted logistic regression model was performed to identify predictors of procedural errors. The most observed errors were internal gaps at the bonding interface and internal voids. Molars had 0.39 the risk of internal voids (odds ratio [OR] = 0.39; confidence interval [CI] = 0.25 – 0.60; P = <0.0001), 0.41 the risk of sharp angle (OR = 0.41; CI = 0.24 – 0.68; P = <0.001), and 0.57 the risk of open contact (OR = 0.57; CI = 0.34 – 0.97; P = 0.04) compared to premolars. Those who were >40 years of age had 1.79 the risk of overhang compared to younger patients (OR = 1.79; CI = 1.04 – 3.11; P = <0.04). First molars and premolars had 0.64 the risk of overhang compared to second molars and premolars (OR = 0.64; CI = 0.41 – 1.00; P = 0.04). Junior students had 1.97 the risk of internal gap compared to their senior counterparts (OR = 1.97; CI = 1.20 – 3.21; P = 0.008). Mesial restorations had 0.38 the risk of external gap compared to mesio-occluso-distal (MOD) restorations (OR = 0.38; CI = 0.19 – 0.78; P = 0.003). Restorations with a margin coronal to the cemento-enamel junction (CEJ) had 0.44 the risk of external gap compared to those restorations with a margin apical to the CEJ (OR = 0.44; CI = 0.29 – 0.66; P = <0.0001). Our findings suggested a higher incidence of procedural errors in restoring premolars and MOD cavity preparations. Therefore, it is crucial to enhance the comprehensiveness of laboratory training and expose students to diverse clinical scenarios and various techniques. [ABSTRACT FROM AUTHOR]

Study design: Retrospective Cohort Study Objectives: To compare early postoperative radiological and clinical outcomes between 2-level minimally invasive (MIS) trans-psoas lateral lumbar interbody fusion (LLIF) and MIS transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spinal stenosis. Methods: Fifty three consecutive patients undergoing 2-level lumbar interbody fusion from L3-L5 for degenerative lumbar spinal stenosis were enrolled. Twenty four patients underwent LLIF and 29 underwent TLIF. Results: Operative time and length of stay were similar between LLIF and TLIF (272.8 ± 82.4 vs 256.1 ± 59.4 minutes; 5.5 ± 2.8 vs 4.7 ± 3.3 days, P >.05), whereas blood loss was lower for LLIF (229.0 ± 125.6 vs 302.4 ± 97.1mls, P =.026). Neurological deficits were more common in LLIF (9 vs 3, P =.025), whereas persistent deficits were rare for both (1 vs 1, P = 1). For both groups, all patient reported outcomes visual analogue scale (VAS back pain, VAS leg pain, ODI, SF-36 physical) improved from preoperative to 2-years postoperative (P <.05), with both groups showing no significant differences in extent of improvement for any outcome. Lateral lumbar interbody fusion demonstrated superior restoration of disc height (L3-L4: 4.1 ± 2.4 vs 1.2 ± 1.9 mm, P <.001; L4-L5: 4.6 ± 2.4 vs.8 ± 2.8 mm, P <.001), foraminal height (FH) (L3-L4: 3.5 ± 3.6 vs 1.0 ± 3.6 mm, P =.014; L4-L5: 3.0 ± 3.5 vs -.1 ± 4.4 mm, P =.0080), segmental lordosis (4.1 ± 6.4 vs -2.1 ± 8.1°, P =.005), lumbar lordosis (LL) (4.1 ± 7.0 vs -2.3 ± 12.6°, P =.026) and pelvic incidence-lumbar lordosis (PI-LL) mismatch (−4.1 ± 7.0 vs 2.3 ± 12.6°, P =.019) at 2-years follow-up. Conclusion: The superior radiological outcomes demonstrated by 2-level trans-psoas LLIF did not translate into difference in clinical outcomes compared to 2-level TLIF at the 2-years follow-up, suggesting both approaches are reasonable for 2-level lumbar interbody fusion in degenerative lumbar spinal stenosis. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the relationship between measures of radiographic joint space width (JSW) loss and magnetic resonance imaging (MRI)-based cartilage thickness loss in the medial weight-bearing region of the tibiofemoral joint over 12–24 months. To stratify this relationship by clinically meaningful subgroups (sex and pain status). Design: We analyzed a subset of knees (n ​= ​256) from the Osteoarthritis Initiative (OAI) likely in early stage OA based on joint space narrowing (JSN) measurements. Natural logarithm transformation was used to approximate near normal distributions for JSW loss. Pearson Correlation coefficients described the relationship between ln-transformed JSW loss and several versions of deep learning-derived MRI-based cartilage thickness loss parameters (minimum, maximum, and mean) in subregions of the femoral condyle, tibial plateau, and combined femoral and tibial regions. Linear mixed-effects models evaluated the associations between the ln-transformed radiographic and MRI-derived measures including potential confounders. Results: We found weak correlations between ln-transformed JSW loss and MRI-based cartilage thickness ranging from R ​= ​−0.13 (p ​= ​0.20) to R ​= ​0.26 (p ​

The evaluation of conventional two-dimensional radiography is crucial in making the diagnosis of periodontitis. Radio-visiography (RVG) is one of the digital imaging modalities that have received significant recognition as a replacement for film-based radiography due to its improved image quality, quick turnaround time, and minimal radiation dose. In order to compare the diagnostic efficacy of Direct Digital and Conventional Intraoral Peri-apical Radiographs in identifying Interdental Bone Loss, the present investigation was carried out. A cross-sectional observational study was conducted among 96 patients prospectively. Radiographs were exposed using a Gendex Oralix AC machine. Statistical data was analyzed using IBM SPSS statistical software using appropriate statistical tests. For both age categories, the radiographic method yielded a higher mean score than the periodontal probe method. The mean scores were noted to be higher following surgery. The radiographic approach recorded a greater mean score when gender groups were compared than the periodontal probe, which had a lower mean score. The mean scores after surgery were noted to be lower than the radiography approach and higher than the periodontal probe. The results demonstrate the radiographic technique’s significant advantage over clinical tests in determining furcation regions as well as its superior accuracy in spotting periodontal disintegration over clinical probing.

Aims: It is important to analyze objectively the hammering sound in cup press-fit technique in total hip arthroplasty (THA) in order to better understand the change of the sound during impaction. We hypothesized that a specific characteristic would present in a hammering sound with successful fixation. We designed the study to quantitatively investigate the acoustic characteristics during cementless cup impaction in THA. Methods: In 52 THAs performed between November 2018 and April 2022, the acoustic parameters of the hammering sound of 224 impacts of successful press-fit fixation, and 55 impacts of unsuccessful press-fit fixation, were analyzed. The successful fixation was defined if the following two criteria were met: 1) intraoperatively, the stability of the cup was retained after manual application of the torque test; and 2) at one month postoperatively, the cup showed no translation on radiograph. Each hammering sound was converted to sound pressures in 24 frequency bands by fast Fourier transform analysis. Basic patient characteristics were assessed as potential contributors to the hammering sound. Results: The median sound pressure (SP) of successful fixation at 0.5 to 1.0 kHz was higher than that of unsuccessful fixation (0.0694 (interquartile range (IQR) 0.04721 to 0.09576) vs 0.05425 (IQR 0.03047 to 0.06803), p < 0.001). The median SP of successful fixation at 3.5 to 4.0 kHz and 4.0 to 4.5 kHz was lower than that of unsuccessful fixation (0.0812 (IQR 0.05631 to 0.01161) vs 0.1233 (IQR 0.0730 to 0.1449), p < 0.001; and 0.0891 (IQR 0.0526 to 0.0891) vs 0.0885 (IQR 0.0716 to 0.1048); p < 0.001, respectively). There was a statistically significant positive relationship between body weight and SP at 0.5 to 1.0 kHz (p < 0.001). Multivariate analyses indicated that the SP at 0.5 to 1.0 kHz and 3.5 to 4.0 kHz was independently associated with the successful fixation. Conclusion: The frequency bands of 0.5 to 1.0 and 3.5 to 4.0 kHz were the key to distinguish the sound characteristics between successful and unsuccessful press-fit cup fixation. Cite this article: Bone Jt Open 2024;5(3):154–161.

Abstract Malalignment in the lower limb structure occurs due to various causes. Accurately evaluating limb alignment in situations where malalignment needs correction is necessary. To create an automated support system to evaluate lower limb alignment by quantifying mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) on full-length weight-bearing radiographs of both lower extremities. In this retrospective study, we analysed 404 radiographs from one hospital for algorithm development and testing and 30 radiographs from another hospital for external validation. The performance of segmentation algorithm was compared to that of manual segmentation using the dice similarity coefficient (DSC). The agreement of alignment parameters was assessed using the intraclass correlation coefficient (ICC) for internal and external validation. The time taken to load the data and measure the four alignment parameters was recorded. The segmentation algorithm demonstrated excellent agreement with human-annotated segmentation for all anatomical regions (average similarity: 89–97%). Internal validation yielded good to very good agreement for all the alignment parameters (ICC ranges: 0.7213–0.9865). Interobserver correlations between manual and automatic measurements in external validation were good to very good (ICC scores: 0.7126–0.9695). The computer-aided measurement was 3.44 times faster than was the manual measurement. Our deep learning-based automated measurement algorithm accurately quantified lower limb alignment from radiographs and was faster than manual measurement.

Background: Mandibular third molar is prone to impaction, resulting in its inability to erupt into the oral cavity. The radiographic examination is required to support the odontectomy of impacted teeth. The use of computer-aided diagnosis based on deep learning is emerging in the field of medical and dentistry with the advancement of artificial intelligence (AI) technology. This review describes the performance and prospects of deep learning for the detection, classification, and evaluation of third molar-mandibular canal relationships on panoramic radiographs. Methods: This work was conducted using three databases: PubMed, Google Scholar, and Science Direct. Following the literature selection, 49 articles were reviewed, with the 12 main articles discussed in this review. Results: Several models of deep learning are currently used for segmentation and classification of third molar impaction with or without the combination of other techniques. Deep learning has demonstrated significant diagnostic performance in identifying mandibular impacted third molars (ITM) on panoramic radiographs, with an accuracy range of 78.91% to 90.23%. Meanwhile, the accuracy of deep learning in determining the relationship between ITM and the mandibular canal (MC) ranges from 72.32% to 99%. Conclusion: Deep learning-based AI with high performance for the detection, classification, and evaluation of the relationship of ITM to the MC using panoramic radiographs has been developed over the past decade. However, deep learning must be improved using large datasets, and the evaluation of diagnostic performance for deep learning models should be aligned with medical diagnostic test protocols. Future studies involving collaboration among oral radiologists, clinicians, and computer scientists are required to identify appropriate AI development models that are accurate, efficient, and applicable to clinical services.

Glandular Odontogenic Cyst (GOC) is a rare odontogenic cyst that indicates the pluripotency of the oral epithelium due to the exhibition of glandular characteristics. It is more prevalent in the mandibular anterior region and shows a predilection in males. The cyst was first described by Padayachee and van Wyk in 1987. It has non distinct clinical and radiographic features but very characteristic histopathological features. Here, the authors report a rare case of GOC occurring in a 36-year-old male patient in the maxillary anterior region. An intraoral periapical radiograph revealed a large unilocular radiolucency from the apex of 11 to the mesial aspect of 15. The cyst was enucleated under local anaesthesia, and endodontic treatment was performed for the associated teeth. No recurrence was seen at the two-month follow-up.

Abstract Background This prospective study aimed to evaluate the influence of the computer type (tablet or desktop) on accuracy and tracing time of cephalometric analyses. Methods Dental students used a web-based application specifically developed for this purpose to perform cephalometric analyses on tablet and desktop computers. Landmark locations and timestamps were exported to measure the accuracy, successful detection rate and tracing time. Reference landmarks were established by six experienced orthodontists. Statistical analysis included reliability assessment, descriptive statistics, and linear mixed effect models. Results Over a period of 8 semesters a total of 277 cephalometric analyses by 161 students were included. The interrater reliability of the orthodontists establishing the reference coordinates was excellent (ICC > 0.9). For the students, the mean landmark deviation was 2.05 mm and the successful detection rate for the clinically acceptable threshold of 2 mm suggested in the literature was 68.6%, with large variations among landmarks. No effect of the computer type on accuracy and tracing time of the cephalometric analyses could be found. Conclusion The use of tablet computers for cephalometric analyses can be recommended.

We present two cases of iatrogenic retroperitoneal perforation involving the ascending and descending colon. The unique imaging findings in these two cases demonstrate potential routes of communication for air originating in the retroperitoneum. In context of these cases, we review the clinical presentation, management, and anatomic features of retroperitoneal perforation. Along with clinical history, an understanding of retroperitoneal anatomic relationships can aid radiologists in identifying the origin of perforation.

Objective: Measuring the severity of the lateral spinal curvature, or Cobb angle, is critical for monitoring and making treatment decisions for children with adolescent idiopathic scoliosis (AIS). However, manual measurement is time-consuming and subject to human error. Therefore, clinicians seek an automated measurement method to streamline workflow and improve accuracy. This paper reports on a novel machine learning algorithm of cascaded convolutional neural networks (CNN) to measure the Cobb angle on spinal radiographs automatically. Methods: The developed method consisted of spinal column segmentation using a CNN, vertebra localization and segmentation using iterative vertebra body location coupled with another CNN, point-set registration to correct vertebra segmentations, and Cobb angle measurement using the final segmentations. Measurement performance was evaluated with the circular mean absolute error (CMAE) and percentage within clinical acceptance ( $\le 5^{\circ }$ ) between automatic and manual measurements. Analysis was separated by curve severity to identify any potential systematic biases using independent samples Student’s t-tests. Results: The method detected 346 of the 352 manually measured Cobb angles (98%), with a CMAE of 2.8° and 91% of measurements within the 5° clinical acceptance. No statistically significant differences were found between the CMAEs of mild ( $ < 25^{\circ }$ ), moderate (25°-45°), and severe ( $\ge 45^{\circ }$ ) groups. The average measurement time per radiograph was 17.7±10.2s, improving upon the estimated average of 30s it takes an experienced rater to measure. Additionally, the algorithm outputs segmentations with the measurement, allowing clinicians to interpret measurement results. Discussion/Conclusion: The developed method measured Cobb angles on radiographs automatically with high accuracy, quick measurement time, and interpretability, suggesting clinical feasibility.

Arthroplasty-related pseudotumors are nonneoplastic and noninfectious inflammatory masses that are typically associated with adverse reaction to metal debris. Pseudotumors most commonly occur in the setting of metal-on-metal joint replacements at the hip. However, the presentation of pseudotumor at the shoulder is exceedingly rare. In this article, we reported a case of arthroplasty-related pseudotumor of the scapula. Clinical history, radiologic signs, and tissue analysis are described. Knowledge of this rare diagnosis will support clinical decision making for teams of radiologists, pathologists, oncologists, and orthopaedic surgeons who provide care for patients presenting with suspicious shoulder masses.

Glandular Odontogenic Cyst (GOC) is a rare odontogenic cyst that indicates the pluripotency of the oral epithelium due to the exhibition of glandular characteristics. It is more prevalent in the mandibular anterior region and shows a predilection in males. The cyst was first described by Padayachee and van Wyk in 1987. It has non distinct clinical and radiographic features but very characteristic histopathological features. Here, the authors report a rare case of GOC occurring in a 36-year-old male patient in the maxillary anterior region. An intraoral periapical radiograph revealed a large unilocular radiolucency from the apex of 11 to the mesial aspect of 15. The cyst was enucleated under local anaesthesia, and endodontic treatment was performed for the associated teeth. No recurrence was seen at the two-month follow-up. [ABSTRACT FROM AUTHOR]

Mandibular third molar is prone to impaction, resulting in its inability to erupt into the oral cavity. The radiographic examination is required to support the odontectomy of impacted teeth. The use of computer-aided diagnosis based on deep learning is emerging in the field of medical and dentistry with the advancement of artificial intelligence (AI) technology. This review describes the performance and prospects of deep learning for the detection, classification, and evaluation of third molar-mandibular canal relationships on panoramic radiographs. This work was conducted using three databases: PubMed, Google Scholar, and Science Direct. Following the literature selection, 49 articles were reviewed, with the 12 main articles discussed in this review. Several models of deep learning are currently used for segmentation and classification of third molar impaction with or without the combination of other techniques. Deep learning has demonstrated significant diagnostic performance in identifying mandibular impacted third molars (ITM) on panoramic radiographs, with an accuracy range of 78.91% to 90.23%. Meanwhile, the accuracy of deep learning in determining the relationship between ITM and the mandibular canal (MC) ranges from 72.32% to 99%. Deep learning-based AI with high performance for the detection, classification, and evaluation of the relationship of ITM to the MC using panoramic radiographs has been developed over the past decade. However, deep learning must be improved using large datasets, and the evaluation of diagnostic performance for deep learning models should be aligned with medical diagnostic test protocols. Future studies involving collaboration among oral radiologists, clinicians, and computer scientists are required to identify appropriate AI development models that are accurate, efficient, and applicable to clinical services. [ABSTRACT FROM AUTHOR]

Characterizing dispersal structures is crucial for species identification and selecting diverse germplasm. This study aimed to investigate the morphology of Spondias tuberosa dispersion units and assess the efficacy of x-ray imaging in characterizing their internal morphology. X-ray imaging successfully revealed the internal structures, enabling the identification of filled, translucent, malformed, and empty seeds. The morphological analysis provided valuable insights into the dispersal units and presented a non-destructive and efficient method for future germplasm research. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study was to develop a robust machine-learning approach for efficient detection and grading of sesamoiditis in horses using radiographs, specifically in data-limited conditions. SAMPLE: A dataset of 255 dorsolateral-palmaromedial oblique (DLPMO) and dorsomedial-palmarolateral oblique (DMPLO) equine radiographs were retrospectively acquired from Hagyard Equine Medical Institute. These images were anonymized and classified into 3 categories of sesamoiditis severity (normal, mild, and moderate). METHODS: This study was conducted from February 1, 2023, to August 31, 2023. Two RetinaNet models were used in a cascaded manner, with a self-attention module incorporated into the second RetinaNet's classification subnetwork. The first RetinaNet localized the sesamoid bone in the radiographs, while the second RetinaNet graded the severity of sesamoiditis based on the localized region. Model performance was evaluated using the confusion matrix and average precision (AP). RESULTS: The proposed model demonstrated a promising classification performance with 92.7% accuracy, surpassing the base RetinaNet model. It achieved a mean average precision (mAP) of 81.8%, indicating superior object detection ability. Notably, performance metrics for each severity category showed significant improvement. CLINICAL RELEVANCE: The proposed deep learning-based method can accurately localize the position of sesamoid bones and grade the severity of sesamoiditis on equine radiographs, providing corresponding confidence scores. This approach has the potential to be deployed in a clinical environment, improving the diagnostic interpretation of metacarpophalangeal (fetlock) joint radiographs in horses. Furthermore, by expanding the training dataset, the model may learn to assist in the diagnosis of pathologies in other skeletal regions of the horse. [ABSTRACT FROM AUTHOR]

The Psittacidae family is made up of several species. Among the native species in Brazil, the Caatinga parakeet (Eupsittula cactorum) is found abundantly in the Caatinga and Cerrado biomes. In the respiratory system, there are certain structural particularities, this system represents a significant target for infections or impairment related to creation, with radiology being an important tool in the evaluation of these anatomical structures and in the diagnosis of pathologies. Thus, the use of radiography in monitoring a case of pneumonia in a Caatinga parakeet was crucial in determining its progression. After the prescribed treatment, a second radiograph was taken, and, together with the clinical evaluation of the animal upon return, it was confirmed that the treatment was effective. [ABSTRACT FROM AUTHOR]

The twister, an unconventional pet, requires careful sanitary management to avoid vulnerability to specific agents, especially those affecting the respiratory system. Untreated cases can evolve into severe situations that may become emergencies, and chest radiography is essential to determine the appropriate intervention. In this way, a twister was brought in for clinical care with dyspnea, was referred for hospitalization, and after stabilization underwent a chest radiograph that revealed pneumothorax and atelectasis. The animal underwent a relieving thoracentesis, showing a considerable clinical improvement. Unfortunately, it succumbed to its condition hours later. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Children are more likely to develop Langerhans cell histiocytosis (LCH), a rare disorder with an unknown cause. LCH often invades skeletal systems, while it has occasionally been seen in the sternum or ribs. The best course of treatment for single‐site, skeletal LCH is yet unknown. We present an instance of sternal LCH with adult onset. By fusing and reconstructing chest computed tomography, it was possible to determine the extent of surrounding soft tissue invasion. Because LCH is so uncommon, it could be challenging to recall when we see a sternal lesion. Adult Patients who arrive with anterior chest discomfort and an osteolytic sternal lesion should include LCH on their differential diagnosis list. [ABSTRACT FROM AUTHOR]

Arthroplasty-related pseudotumors are nonneoplastic and noninfectious inflammatory masses that are typically associated with adverse reaction to metal debris. Pseudotumors most commonly occur in the setting of metal-on-metal joint replacements at the hip. However, the presentation of pseudotumor at the shoulder is exceedingly rare. In this article, we reported a case of arthroplasty-related pseudotumor of the scapula. Clinical history, radiologic signs, and tissue analysis are described. Knowledge of this rare diagnosis will support clinical decision making for teams of radiologists, pathologists, oncologists, and orthopaedic surgeons who provide care for patients presenting with suspicious shoulder masses. [ABSTRACT FROM AUTHOR]

We present two cases of iatrogenic retroperitoneal perforation involving the ascending and descending colon. The unique imaging findings in these two cases demonstrate potential routes of communication for air originating in the retroperitoneum. In context of these cases, we review the clinical presentation, management, and anatomic features of retroperitoneal perforation. Along with clinical history, an understanding of retroperitoneal anatomic relationships can aid radiologists in identifying the origin of perforation. [ABSTRACT FROM AUTHOR]

Purpose The study aimed to compare postoperative pain after root canal preparation using three different methods of working length determination. Materials and Methods 60 patients diagnosed with symptomatic irreversible pulpitis were randomly divided into three groups based on the method of working length (WL) determination. Group 1: digital radiograph (DRG), Group 2: electronic apex locator (EAL), Group 3: the simultaneous working length control (SLC) method using an endomotor with an integrated apex locator. The root canal treatments were completed in a single visit, and patients were asked to record their pain response using the Visual Analog Scale (VAS) at 6, 24, 48, and 72 hours postoperatively. Results Group 1 (DRG) recorded the highest postoperative pain score, while the lowest was recorded by Group 3 (SLC). There was a statistically significant difference in the VAS pain scores between DRG and SLC (p<0.05) at 6-, 24- and 48-hour intervals. Conclusion Within the limitations of this study, it can be concluded that the SLC can be a helpful working length determination technique to reduce postoperative pain. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the usefulness of procalcitonin (PCT) as a point-of-care testing to screen for radiographic pneumonia among children with influenza-like illness (ILI) and prolonged fever. Methods: A prospective cohort study conducted at the pediatric emergency department of a tertiary hospital. Point-of-care testing for PCT was determined for 185 children aged 3 months to < 18 years with ILI and fever lasting > 4 days seen during the flu season in 2020. A chest radiograph (CXR) was performed for patients with PCT > 0.5 ng/mL. Results: PCT value was > 0.5 ng/mL in 46 (24.9%) patients; a CXR was ordered in all cases except one and 14 (31.1%) of them had radiographic pneumonia (all had a PCT value > 0.7 ng/mL). Among the 139 (75.1%) patients with a PCT value ≤ 0.5 ng/mL, 137 (98.6%) were managed in the outpatient with symptomatic treatment; the remaining two cases warranted a CXR which was unremarkable in both. At evolution, no radiographic pneumonia was diagnosted in any of them. Conclusion: PCT is a useful tool for point-of-care testing in patients with ILI and fever > 4 days to guide the indication for CXR to rule out radiographic pneumonia and helps in avoiding unnecessary radiation exposure. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: It is estimated that $12.8 billion to $28.6 billion is wasted annually on unnecessary imaging studies and treatment in the United States. This is especially important to the pediatric population, which is unable to make decisions for themselves and vulnerable to radiation exposure. We hypothesized that a significant number of unnecessary radiographs are performed in the pediatric emergency department (ED), leading to excessive time, cost, and radiation exposure to pediatric patients. Methods: We retrospectively reviewed 406 patients who were evaluated in a pediatric ED for possible fractures at a single institution during the 2020 calendar year. Records were reviewed for demographics, history, and physical exams, as well as the sequential order which radiographs were performed. All radiographs were evaluated by the senior author to determine if they resulted in a change in management. All data were recorded and analyzed by the senior author and our statistician using Student’s t-test. Results: 406 patient encounters were included. 2,807 radiographs were deemed unnecessary, with an average of 6.9 radiographs per patient. $454,734 was spent on radiographs that ultimately did not change management. A total of 216 hours and 43 minutes was spent in the X-ray suite alone, for an average of 32 minutes per patient. The estimated amount of radiation exposure that did not change management was potentially as high as 69 millirem per patient. Conclusions: There is an excessive amount of monetary waste, radiation exposure, and encounter time spent with pediatric Orthopaedic patients in the ED. There are several potential strategies to alleviate this problem, which we hope can be taken into consideration to help address this widespread health care issue. Key Concepts: (1) There are a substantial number of unnecessary radiographs performed in the pediatric ED both during diagnosis and treatment of fractures. (2) This unnecessarily increases the time, cost, and radiation exposure that pediatric patients experience. (3) Several possible strategies exist to reduce this waste including obtaining films after a careful physical exam, consider which views would be most beneficial, whether the joint above and below would truly be needed, using fluoroscopy in the ED during reduction and casting and limiting post splinting or casting imaging if there was no or minimal formal reduction. Level of Evidence: III

ABSTRACT: Radiographic evaluation of hip pain in adolescents and young adults is an important component of the assessment to aid in the identification of the cause of pain, distinguish between etiologies of early hip degeneration such as acetabular dysplasia (instability) and femoroacetabular impingement, and guide further workup and management. Recent advances in radiographic assessment include the importance of obtaining a standing anterior-posterior radiograph to illustrate the functional position of the pelvis, the use of anterior and posterior wall indices to illustrate anterior and posterior wall coverage and the importance of interpreting radiographic measures in the context of a patient’s sagittal balance. Advances in magnetic resonance imaging, computed tomography, and ultrasound have also occurred and can provide further diagnostic clarity. The purpose of this work is to review the literature to provide a systematic approach to the radiographic evaluation of hip pain in skeletally mature adolescents and young adults. Key Concepts: (1) The standing AP pelvis, 45° Dunn, and false-profile views provide a preliminary comprehensive radiographic assessment of the symptomatic hip in the skeletally mature adolescent and young adult and help to distinguish between instability and impingement. (2) The Lateral Center Edge Angle (LCEA) should be augmented by the anterior center edge angle (ACEA), anterior wall index (AWI), and posterior wall index (PWI) to obtain a more complete understanding of 3-dimensional femoral head coverage from plain radiographs. (3) While the crossover and posterior wall signs on radiographs can be helpful in screening for acetabular retroversion and anteversion, CT should be used to confirm if considering reorientation or resection. (4) Cam morphology should be quantitatively assessed using the alpha angle and head-neck offset on the 45° Dunn view. (5) Dynamic ultrasound may be useful in illustrating the motion associated with impingement and instability in real-time but may be limited by the technician-dependent nature of this modality.

We are presenting a rare case of a 29-year-old male patient with congenital pseudoarthrosis of the clavicle who presented in adulthood with a progressively growing lump on medial end of clavicle which after investigations tuned out to be pseudoarthrosis of the medial clavicle.

Introduction: The Intertrochanteric fracture is a common hip trauma encountered in elderly patients. There is a lack of general agreement regarding its surgical management and choice of implant. Purpose of this study to conclude the final decision matrix regarding surgical management of intertrochanteric fractures based on parameters assessed on plain radiographs and CT scan. Materials and methods: We have retrospectively evaluated 55 patients with intertrochanteric fractures presented to our institute after informed consent with radiographs and CT scans between July 2017 to July 2018. Assessment of various parameters regarding fracture geometry and classification as well as measurement was done. Results: Mean lateral wall thickness in present study was 20.76mm. Incidence of coronal fragments was 90.9% and absence of coronal fragment in 5 patients. We noted the cases with anterior comminution had also a posterior comminution rendered the fracture unstable in almost 20 % cases. Conclusion: Better understanding of fracture geometry by combined used of radiograph and CT scan enhanced preoperative planning, choice of suitable implant, helps in reduction manoeuvre and improving quality of osteosynthesis.