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Image retake of radiological examinations not only increases the risk of radiation exposure of the patients, but also wastes the medical resource and degrades the quality of services of the hospitals. This study aimed at discovering factors affecting image retake of general digital radiography for setting guidelines to reduce the image retaking rate. A total of 98,503 general X-ray images retrieved from the picture archiving and communication system database of a medical center in central Taiwan were analyzed. The results showed that the total retaking rate was 4.89% with the position error (56.05%) was the main factor causing image retakes and chest examination showed the highest frequency (1544 cases). On the other hand, skull/face exhibited the highest retaking rate (9.81%) among various types of examinations. After discovering the factors affecting the image retaking rate, suitable guidelines were proposed and introduced. The image retake rate had been significantly reduced to 4.38% and 3.57% 1 month and 6 months, respectively, after the introduction of guidelines. In conclusion, image retake analysis is a quality indicator and is effective for quality assurance of digital radiology. Regular analysis of image retake can find factors inducing image retake and is useful for designing guidelines to reduce the image retake rate.

Summary Objective Incomplete uterine perforation after intrauterine device (IUD) insertion has occasionally been observed. We report on three patients who underwent flexible hysteroscopy for localization and retrieval of these intramural devices. Case Reports Three Taiwanese women presented with lower abdominal pain, discomfort during defecation and frequent urination. All used a Nova-T IUD for contraception. Sonography suggested dislocation of the IUD or perforation, and pelvic examination revealed missing strings. All the women underwent flexible hysteroscopy to localize and retrieve the devices. The hysteroscopic examination indicated partial perforation or embedding of the device into the cervical or uterine wall. Retrieval was smoothly performed without cervical dilatation or anesthesia in all three women. All devices were directly retrieved using the grasping forceps of the flexible hysterofibroscope. The subsequent courses were smooth and uneventful. Conclusion Flexible hysteroscopy is a simple and useful tool for diagnosis and retrieval of intramural IUDs. The instant removal of an IUD that has incompletely perforated the uterine wall might prevent complete uterine perforation.

The surgical method of repairing distal tibial fractures remains controversial. Open reduction and plating is a popular method that can result in good fixation and retention of the achieved position. The usual approach for open plating is anterior. Although it offers good exposure to the tibia, the medial plating is at high risk of wound problems and nonunions. Also, if fixation of the fibula is required, an additional incision must be made on the lateral side of the shin. Lateral plating using a single lateral approach for treating distal tibial and fibular fractures has been reported to have good results; however, most of these studies were small series. We retrospectively evaluated and compared the clinical outcomes of distal tibial fractures treated with medial plating using an anterior approach and lateral plating using a lateral approach. Eighty-eight patients with distal tibial fractures treated with medial or lateral plating were retrospectively reviewed. The 88 fractures were divided into 2 groups: the medial plating group used an anterior approach and included 49 patients and the lateral plating group used a lateral approach and included 39 patients. Both groups were similar with respect to injury mechanism, union rate, malunion rate, operative time, functional score, and range of ankle motion (P>or=.14). Both medial and lateral plating for treating distal tibial fractures achieved good functional outcomes with a low malunion rate; however, the lateral plating group had a lower complication rate (P=.047) and fewer hardware problems (P

Removal of intrauterine devices (IUDs) in early pregnancy, when the IUDs threads are not visible at the cervical canal and the patient wishes to continue her pregnancy, remains a problem. Thirty-three patients using IUDs with nonvisible filaments on examination under-went flexible hysteroscopy for retrieval of the devices and follow-up until delivery. In all cases, hysteroscopies were performed without cervical dilatation and anesthesia. In 30 patients, the devices were found within the uterine cavity, and 28 IUDs were removed. In the remaining 3 patients, no IUD was observed. Twenty-four healthy children have been born. Six other patients requested a dilatation and curettage (D & C) about 1–2 weeks later after successful IUD removal. In 2 women, examinations were done at 22 and 29 weeks antepartum, and these 2 patients were lost to follow up. Operative fiberoptic hysteroscopy is proposed as a useful and effective method of retrieval of IUDs in early pregnancy when the filaments of the IUD are ab...

Summary Objective Intrauterine adhesion remains a common complication post dilatation and curettage (D&C) in reproductive females. Internal cervical orifice adhesion (ICA) is also observed incidentally after D&C. Here, we introduce a novel adjunctive management for ICA with cross-type nelaton catheter. Materials and Methods In this study, 20 patients suffering from amenorrhea and ICA after D&C were included. All individuals underwent flexible hysteroscopy to confirm their simple ICA statuses. All women accepted the insertion of simple cross-type nelaton catheter. Two weeks post insertion, the catheter was removed and a secondlook hysteroscopy was performed. Three months post catheter removal, the menstruation statuses and the efficiency of nelaton catheter in preventing ICA were evaluated. Results Nineteen patients had 3-month follow-up. Seventeen individuals (89.4%) had normal menstruation flow as well as the impact internal orifice of cervical canal. Only two patients (10.5%) had hypomenorrhea and fibrotic narrowing of the internal orifice of the cervix, which required resectoscopy to remove the internal cervical adhesions. All patients appeared the competence of endurance for these procedures. Conclusion The novel cross-type nelaton catheter is a simple, well tolerated, and highly effective method for the management of ICA after D&C.

According to Dr. Tatum H. J., et al.: the incidence of spontaneous abortion more than doubled when the IUD remained in utero. The chance of a livebirth being premature was four times greater when the IUD remained in situ that when it was removed. Besides, a certain number of authors have tried their best to remove IUDs in early pregnancies before suction curretage, and they can't follow up after D & C. So the policy at our hospital, in cases where a woman wishes to continue a pregnancy that has occurred with an IUD in situ, is to remove IUD as soon as possible.