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Evaluation has been made of the radiogenic risks to patients and personnel during 99mTc diagnostic nuclear medicine examinations. A highly sensitive form of thermoluminescent dosimeter, type TLD-GR200A (LiF: Mg, Cu, P), was used to quantify occupational exposure. Ambient exposure rates and patient doses were also assessed using a survey meter and knowledge of the administered activity respectively. For bone, renal and thyroid scans, the mean 99mTc administered activities were 925.0 MBq, 148.0 MBq and 166.5 MBq respectively. The staff annual dose was estimated to be 11.2 mSv and eye lens dose equivalent was 2.2 mSv. The dose values are greater in comparison with other studies but with the current workload and practices they remain within the annual occupational dose limit. [ABSTRACT FROM AUTHOR]

Purpose: We aim to develop modified clinical indication (CI)-based image quality scoring criteria (IQSC) for assessing image quality (IQ) and establishing acceptable quality doses (AQDs) in adult computed tomography (CT) examinations, based on CIs and patient sizes., Approach: CT images, volume CT dose index ( CTDI vol ), and dose length product (DLP) were collected retrospectively between September 2020 and September 2021 for eight common CIs from two CT scanners at a central hospital in the Kingdom of Bahrain. Using the modified CI-based IQSC and a Likert scale (0 to 4), three radiologists assessed the IQ of each examination. AQDs were then established as the median value of CTDI vol and DLP for images with an average score of 3 and compared to national diagnostic reference levels (NDRLs)., Results: Out of 581 examinations, 60 were excluded from the study due to average scores above or below 3. The established AQDs were lower than the NDRLs for all CIs, except AQDs / CTDI vol for oncologic follow-up for large patients (28 versus 26 mGy) in scanner A, besides abdominal pain for medium patients (16 versus 15 mGy) and large patients (34 versus 27 mGy), and diverticulitis/appendicitis for medium patients (15 versus 12 mGy) and large patients (33 versus 30 mGy) in scanner B, indicating the need for optimization., Conclusions: CI-based IQSC is crucial for IQ assessment and establishing AQDs according to patient size. It identifies stations requiring optimization of patient radiation exposure., (© 2024 Society of Photo-Optical Instrumentation Engineers (SPIE).)

Background: Femur shaft factures (FSF) are common injuries following high-energy mechanisms mainly involving motor vehicle crashes (MVC). We evaluated the timings of nailing management and analyzed the pattern of fracture union and outcome in a level 1 trauma center., Methods: This was a retrospective observational study of all the admitted trauma patients who sustained femoral fractures between January 2016 and September 2020. Data were analyzed and compared based on time to Intramedullary Nailing (IMN) (<12 h, 12-24 h and >24 h) and outcomes of FSF (union, delayed union and nonunion)., Results: A total of 668 eligible patients were included in the study, of which the majority were males (90.9%) with a mean age of 34.5 ± 15.8, and 54% of the injuries were due to MVCs. The chest (35.8%) was the most commonly associated injured body region, followed by the pelvis (25.9%) and spine (25.4%). Most of femur fractures (93.3%) were unilateral, and 84.4% were closed fractures. The complete union of fractures was observed in 76.8% of cases, whereas only 4.2% and 3.3% cases had delayed union and nonunion, respectively, on the clinical follow-up. Patients in the delayed IMN (>24 h) were severely injured, had bilateral femur fracture ( p = 0.001) and had higher rate of external fixation, blood transfusion, pulmonary complications and prolonged hospitalization. Non-union proportion was greater in those who had IMN <24 h, whereas a delayed union was greater in IMN done after 24 h ( p = 0.5). Those with a nonunion femur fracture were more likely to have bilateral fracture ( p = 0.003), frequently had retrograde nailing ( p = 0.01), and high-grade femur fracture (AO type C; p = 0.04)., Conclusion: This study showed that femur fracture is not uncommon (8.9%), which is manifested with the variety of clinical characteristics, depending on the mechanism, management and outcome in our center. Bilateral fracture, retrograde nailing and AO classification type C were the significant risk factors of non-union in patients with diaphyseal fractures. The timing of IMN has an impact on the fracture union; however, it is not a statistically significant difference. Therefore, the treating physicians should consider the potential risk factors for a better outcome by careful selection of treatment in sub-groups of patients.

Introduction and Importance: Bilateral femoral neck fractures in young adults are a rare entity. It is usually associated with pre-existing metabolic diseases, such as osteoporosis, renal osteodystrophy, or hypocalcemic seizures. Hence, it is essential in such cases to look for other associated injuries following a traumatic event. Missing associated injuries may lead to significant morbidities and poor functional outcomes., Case Presentation: A 37 years old male, who had chronic renal failure secondary to hypertension, and presented to the emergency room following a seizure episode, in which he developed a generalized tonic-clonic convulsion secondary to electrolyte imbalances with metabolic acidosis. As a result, he developed bilateral neck of femur fracture., Intervention and Outcome: The medical team optimized electrolytes imbalance and then the patient underwent surgical stabilization of both femur neck fracture, 1 year following the surgical fixation the patient had full range of motion of both hips with radiological evidence of complete healing of the fracture., Conclusion: In cases of fractures secondary to metabolic conditions, bilateral femoral neck fractures should be suspected and investigated; especially in young patients who develop a generalized tonic-clonic seizure. The etiology is multifactorial, and the treating surgeon should be aware of predisposing factors which may affect bone quality, thereby raising the risk of fractures even with low-energy atraumatic events. Hip preservation should always be the primary target when treating these patients., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Pediatric pelvic fractures (PPF) are uncommon among children requiring hospitalization after blunt trauma. The present study explored our experience for the prevalence, patients demographics, clinical characteristics, injury pattern and management of pediatric pelvic fractures in a level I trauma center., Methods: This is a retrospective review of prospectively collected data obtained from trauma registry database for all pediatrics trauma patients of age ≤18 years. Data were analyzed according to different aspects relevant to the clinical applications such as Torode classification for pelvic ring fracture (Type I-IV), open versus closed triradiate cartilage, and surgical versus non-surgical management., Results: During the study period (3 and half years), a total of 119 PPF cases were admitted at the trauma center (11% of total pediatric admissions); the majority had pelvic ring fractures (91.6%) and 8.4% had an acetabular fracture. The mean age of patients was 11.5 ± 5.7, and the majority were males (78.2%). One hundred and four fractures were classified as type I (5.8%), type II (13.5%), type III (68.3%) and type IV (12.5%). Patients in the surgical group were more likely to have higher pelvis AIS (p = 0.001), type IV fractures, acetabular fractures and closed triradiate cartilage as compared to the conservative group. Type III fractures and open triradiate cartilage were significantly higher in the conservative group (p < 0.05). Patients with closed triradiate cartilage frequently sustained spine, head injuries, acetabular fracture and had higher mean ISS and pelvis AIS (p < 0.01) than the open group. However, the rate of in-hospital complications and mortality were comparable among different groups. The overall mortality rate was 2.5%., Conclusion: PPF are uncommon and mainly caused by high-impact trauma associated with multisystem injuries. The majority of PPF are stable, despite the underlying high-energy mechanism. Management of PPF depends on the severity of fracture as patients with higher grade fractures require surgical intervention. Furthermore, larger prospective study is needed to understand the age-related pattern and management of PPF., (© 2021. The Author(s).)

Background: Open reduction and internal fixation through the Kocher-Langenbeck approach is the treatment of choice for selected acetabular fracture patterns. Patient positioning (lateral vs prone) can affect the outcome and post-operative complications., Methods: A retrospective cohort of seventy-three adult patients' with acetabular fractures treated with open reduction and internal fixation through the Kocher-Langenbeck approach in either prone or lateral position. Primary outcome was the quality of radiographic fracture reduction; secondary outcomes included operative time, intra-operative estimated blood loss and pre-operative complications., Results: The demographics and fracture type were similar between the two groups. There was no difference in the quality of reduction using the Matta radiographic grading. Laterally positioned group demonstrated significant shorter surgical time and lower incidence of iatrogenic sciatic nerve injury. There was no difference in estimated blood loss, heterotopic ossification or infection., Conclusion: This study showed no difference in the quality of fracture reduction, intraoperative blood loss, post-operative infection and heterotopic ossification between both groups. Hence, patients' condition, surgeon experience and preference are important factors for deciding patient positioning in the Kocher-Langenbeck approach for acetabulum fracture fixation.

Background: Traumatic pelvic fracture (TPF) is a significant injury that results from high energy impact and has a high morbidity and mortality., Purpose: We aimed to describe the epidemiology, incidence, patterns, management, and outcomes of TPF in multinational level 1 trauma centers., Methods: We conducted a retrospective analysis of all patients with TPF between 2010 and 2016 at two trauma centers in Qatar and Germany., Results: A total of 2112 patients presented with traumatic pelvic injuries, of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41 ± 21 years. In unstable pelvic fracture, the frequent mechanism of injury was motor vehicle crash (41%) followed by falls (35%) and pedestrian hit by vehicle (24%). Apart from both extremities, the chest (37.3%) was the most commonly associated injured region. The mean injury severity score (ISS) of 16.5 ± 13.3. Hemodynamic instability was observed in 44%. Blood transfusion was needed in one third while massive transfusion and intensive care admission were required in a tenth and a quarter of cases, respectively. Tile classification was possible in 1228 patients (type A in 60%, B in 30%, and C in 10%). Patients with type C fractures had higher rates of associated injuries, higher ISS, greater pelvis abbreviated injury score (AIS), massive transfusion protocol activation, prolonged hospital stay, complications, and mortality (p value < 0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stays were 15 and 5 days, respectively. The overall mortality rate was 4.7% (86 patients)., Conclusion: TPF is a common injury among polytrauma patients. It needs a careful, systematic management approach to address the associated complexities and the polytrauma nature.

Background Knee injuries are encountered commonly in the emergency departments (EDs) in Ireland. Validated clinical decision rules such as Ottawa knee rule (OKR) can be used in acute knee injury settings to reduce the number of unnecessary radiography. Clinical judgment can be used to distinguish between suspected fractures and non-fractures in many cases; however, radiography is still routinely requested. Objectives We evaluated the OKRs in a high-volume tertiary teaching hospital in Ireland to determine whether the rule could be safely used to decide whether patients with acute blunt knee trauma should undergo radiography. Methods This was an observational study conducted in the ED over a three-month period in a tertiary referral hospital. A total of 110 patients with acute knee injuries were examined using OKR. Inclusion criteria included patients with acute knee injuries due to blunt trauma or twisting injury and patients with lacerations or contusions. Open fractures and fractures due to penetrating injury were excluded from the study. Results Fractures were seen in 12 (13.2%) of the 110 patents who met the inclusion criteria. The OKR predicted all 12 fractures. Sensitivity was 100%, and specificity was 39%. Conclusions The OKR is highly sensitive for fracture in this setting and can be safely used to decide whether patients with acute blunt knee trauma should undergo radiography., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Mohamed et al.)

Background: We aimed to validate the utility of shock index (SI) in predicting the need of blood transfusion and outcomes in patients with traumatic pelvic fracture (TPF)., Materials and Methods: We conducted a retrospective analysis for patients who sustained TPF between 2012 and 2016 in a level 1 trauma center. Patients were categorized into patients with low versus high SI based on the cutoff obtained from the receiver operating characteristic curves to predict mortality., Results: A total of 966 patients sustained TPF (28.5% had SI ≥ 0.9 based on receiver operating characteristic curves) with a median age of 33 (IQR 25-47) y. Type B and C pelvic fractures significantly had higher SI. The frequency of blood transfusion use was greater in patients with high SI (P = 0.001). SI correlated significantly with Injury Severity Score (r = 0.32), Revised Trauma Score (r = -0.40), and transfused blood units (r = 0.35). Patients with high SI had prolonged hospital length of stay and higher mortality (P = 0.001). SI ≥ 0.9 showed high sensitivity and negative predictive value to identify the need of massive blood transfusion (77% and 86%, respectively) and mortality (73.5% and 98.1%, respectively). For hospital mortality, high SI had a sensitivity of 73.5%, specificity 74%, negative predictive value 98%, and negative likelihood ratio of 0.36. After adjustment for age, sex, Injury Severity Score, Glasgow Coma Scale, pelvis Abbreviated Injury Scale, blood transfusion, and Tile classification, the multivariate analysis models showed that high SI was an independent predictor of blood transfusion (odd ratio 5.6) and mortality (odd ratio 3.63)., Conclusions: SI is a potentially useful instant tool for the prediction of massive transfusion and mortality in patients with TPF. Further prospective studies are warranted to support our findings., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Radiation exposure due to computed tomography (CT) has become an important issue, as the number of CT examinations has been increasing worldwide. Radiation doses associated with CT are higher in comparison to other imaging procedures. CT-related radiation doses should be monitored and controlled in order to ensure reduction of radiation exposure and optimization of image quality. The aim of this study was to evaluate radiation doses in adult patient who underwent routine CT brain examinations, and to assess how CT scanning protocols affect patient doses in practice., Material/methods: A total of 118 patients underwent brain CT at two radiology departments equipped with 64-slice CT scanners, Khartoum, Sudan. Patient doses regarding weighted CT dose index (CTDI w ) and dose length product (DLP) values were recorded. Quality control tests were performed for both scanners., Results: The mean CTDI w values ranged from 62.9 to 65.8 mGy, DLP values ranged from 1003.7 to 1192.5 mGy, and the effective dose varied from 2.4 to 3.7 mSv., Conclusions: Patient doses in this study was higher compared to previous research, suggesting that patients exposed to unnecessary radiation. Therefore, optimization of radiation doses with the use of specified imaging protocols, well-documented indications for CT, training of technicians, and quality control programs will reduce the necessary radiation doses. Establishment of the diagnostic reference level is recommended for further dose reduction.

This study was designed with an aim to detect the congenital anomalies appear to be linked to and in conjunction with hydrocephalus fetuses in Sudan, when ultrasound is used to exam fetuses in the second and third trimesters of pregnancy. This prospective cohort study was performed from December 2011 to December 2013, in a group consists of 5000 single gestation pregnant Sudanese women. In all cases, maternal ages were 35 years up to 48 years; mean age of 42.5 years. Pelvic; obstetric ultrasound scanning protocol used should meet the standards established by the American Institute of Ultrasound in Medicine (AIUM) for scanning in the second and third trimesters of pregnancy. Statistical Package for the Social Sciences (SPSS) was used to analyze the results. Diagnosed hydrocephalus cases (0.4%) were found to be associated with other fetal anomalies as aqueduct stenosis (45%), spina bifida (30%), Arnold-Chiari malformation (20%) and Dandy-Walker malformation (5%). The incidence of congenital anomalies and hydrocephalus in Sudanese fetuses showed considerable variation among different regions of Sudan. Hydrocephalus is associated with certain congenital anomalies. In agreement with previous studies, hydrocephalus is predominantly in male rather than female fetuses. The prevalence of fetal anomalies and hydrocephalus are within previously reported ranges.