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Objective: This retrospective study analyzed radiographic bone levels of 10,871 dental implants in a cohort of 4,247 patients over a 22-year period. The objectives of the study were to assess and explore risk factors associated with the radiographic bone level of dental implants. Method and materials: A longitudinal observational cohort study based on data collected from 1995 to 2019 was conducted on implants placed by a single periodontist. Inclusion criteria included both partially and fully edentulous sites. Exclusion criteria were patients who were considered ASA 3 or greater. Information on medical and dental status prior to implant placement such as diabetes and smoking were included in the analysis. Implant factors such as the implant characteristics (length and diameter) and surgical site were recorded. The outcome assessed was the prevalence of bone loss around implants and any associative factors related to the bone loss. Results: Overall, dental implants lost an average of 0.05 ± 0.38 mm of bone 2 to 3 years after placement and 0.21 ± 0.64 mm 8 years after placement. The soft tissue condition was evaluated using the Implant Mucosal Index (IMI), and bone loss around dental implants was significantly higher when bleeding on probing was multi-point and moderate, multi-point and profuse, and when infection with suppuration was recorded. The mean difference in bone level between smokers and nonsmokers was 0.26 mm (P < .01) over a 4-year period. A mean difference of 0.10 mm (P = .04) in bone loss over 4 years was found between those with an autoimmune disease compared to those without. The diameter of the implant and immediate loading of the dental implant did not influence the radiographic bone levels over time. Conclusions: This large dataset of dental implants highlights predictive risk factors for bone loss around dental implants and the impact these risk factors have on the implant bone level. Consideration of these risk factors by both the dental team and the patient prior to dental implant placement will promote success of the treatment. [ABSTRACT FROM AUTHOR]

When a low-energy trauma induces an acute vertebral fracture (VF) with clinical symptoms, a definitive diagnosis of osteoporotic vertebral fracture (OVF) can be made. Beyond that, a "gold" radiographic standard to distinguish osteoporotic from non-osteoporotic VFs does not exist. Fracture-shaped vertebral deformity (FSVD) is defined as a deformity radiographically indistinguishable from vertebral fracture according to the best of the reading radiologist's knowledge. FSVD is not uncommon among young populations with normal bone strength. FSVD among an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely to be associated with compromised bone strength. In more severe grade deformities or when a vertebra is collapsed, OVF diagnosis can be made with a relatively high degree of certainty by experienced readers. In "milder" cases, OVF is often diagnosed based on a high probability rather than an absolute diagnosis. After excluding known mimickers, singular vertebral wedging in older women is statistically most likely an OLVF. For older women, three non-adjacent minimal grade OLVF (< 20% height loss), one minimal grade OLVF and one mild OLVF (20–25% height loss), or one OLVF with ≥ 25% height loss, meet the diagnosis of osteoporosis. For older men, a single OLVF with < 40% height loss may be insufficient to suggest the subject is osteoporotic. Common OLVF differential diagnoses include X-ray projection artifacts and scoliosis, acquired and developmental short vertebrae, osteoarthritic wedging, oncological deformities, deformity due to high-energy trauma VF, lateral hyperosteogeny of a vertebral body, Cupid's bow, and expansive endplate, among others. [ABSTRACT FROM AUTHOR]

Objective: To determine which bones and which grades had the highest inter-rater variability when employing the Tanner–Whitehouse (T-W) method. Materials and methods: Twenty-four radiologists were recruited and trained in the T-W classification of skeletal development. The consistency and skill of the radiologists in determining bone development status were assessed using 20 pediatric hand radiographs of children aged 1 to 18 years old. Four radiologists had a poor concordance rate and were excluded. The remaining 20 radiologists undertook a repeat reading of the radiographs, and their results were analyzed by comparing them with the mean assessment of two senior experts as the reference standard. Concordance rate, scoring, and Kendall's W were calculated to evaluate accuracy and consistency. Results: Both the radius, ulna, and short finger (RUS) system (Kendall's W = 0.833) and the carpal (C) system (Kendall's W = 0.944) had excellent consistency, with the RUS system outperforming the C system in terms of scores. The repeatability analysis showed that the second rating test, performed after 2 months of further bone age assessment (BAA) practice, was more consistent and accurate than the first. The capitate had the lowest average concordance rate and scoring, as well as the lowest overall concordance rate for its D classification. Moreover, the G classifications of the seven carpal bones all had a concordance rate less than 0.6. The bones with lower Kendall's W were likewise those with lower scores and concordance rates. Conclusion: The D grade of the capitate showed the highest variation, and the use of the Tanner–Whitehouse 3rd edition (T-W3) to determine bone age (BA) was frequently inconsistent. A more comprehensive description with a focus on inaccuracy bones or ratings and a modification to the T-W3 approach would significantly advance BAA. [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. [ABSTRACT FROM AUTHOR]

We aimed to identify when magnetic resonance imaging (MRI) would be useful to diagnose patients with suspected axial spondyloarthropathy (AxSpA) without evidence of sacroiliitis on radiographs. We retrospectively reviewed electronic medical records of patients who underwent pelvis MRI after radiographs at the rheumatology clinic in a single tertiary center in Korea. Patients underwent imaging from January 2020 to July 2022. We collected data including complete blood count, erythrocyte sedimentation rate, C-reactive protein (CRP), human leukocyte antigen (HLA)-B27, history of acute anterior uveitis (AAU), peripheral arthritis, dactylitis, inflammatory bowel disease (IBD), enthesopathy, and psoriasis. A total of 105 patients who showed no evidence of sacroiliitis on radiographs were included. The median age of patients was 41.0 years, and 44.8% were male. Of them, 34 showed sacroiliitis on MRI (group 1), and 71 showed no evidence of sacroiliitis even on MRI (group 2). Known AxSpA-related clinical features including AAU, peripheral arthritis, dactylitis, IBD, enthesopathy, and psoriasis were not different between the two groups. HLA-B27 positivity (79.4% vs. 40.0%, p < 0.001), median white blood cell count (7700 vs. 6300, p = 0.007), mean platelet count (307.7 ± 69.7 vs. 265.3 ± 68.9 × 103/µL, p = 0.005), and median CRP level (0.38 vs. 0.10, p = 0.001) showed significant differences between the two groups. In a multivariate analysis, HLA-B27 positivity and platelet count were significantly associated with sacroiliitis on MRI. In our cohort, sacroiliitis was observed on MRI in one-third of patients without radiographic evidence. MRI could be recommended to evaluate sacroiliitis in patients with positive HLA-B27 and a high platelet count. [ABSTRACT FROM AUTHOR]

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

In order to evaluate the early radiographic characteristics of the lateral talocalcaneal (L-TC) angle in patients with idiopathic clubfoot (ICF) and to investigate its prognostic significance for relapse after initial treatment with the Ponseti method. We retrospectively included 151 patients (96 males and 55 females; 227 feet) with ICF treated at our Institution between January 2005 and December 2014. The age at initial treatment was less than 6 months, and radiographs were obtained within 3 months of the Achilles tenotomy (mean age: 2.3 months; range: 0.77-6.8). All patients were followed up for at least 7 years (range, 7-18). The participants' feet were classified into 3 groups: relapsed (Group A), not relapsed (Group B), and normal foot groups which consisted of healthy feet in patients with unilateral ICF (Group C). All angle measurements were expressed in degrees. Forty-seven ICF feet in 33 patients relapsed, while 180 feet in 118 patients did not, and the age at relapse was 5.92 ± 1.91 years. Seventy-five normal feet were included in Group C. The average L-TC angle in Group A and B patients was 33.57° ± 12.05° and 39.37° ± 12.55°, respectively, while Group C was 49.61° ± 9.11°. A significant difference was found among the 3 groups of patients (F = 31.48, p <.001). The L-TC angle cut-off value below which a recurrence could be predicted was 36.1° (sensitivity, 74.47%). The L-TC angle of ICF patients treated using the Ponseti method were reduced compared to normal feet. An L-TC angle of <36.1° has relative value in predicting ICF relapse. [ABSTRACT FROM AUTHOR]

An 8‐year‐old female domestic shorthair, presenting for a 3‐day history of lethargy and hyporexia, was obtunded, dehydrated, tachypneic, and had abdominal distension on physical exam with no vaginal discharge or pyrexia. Abdominal radiographs revealed a large, ovoid soft tissue mass and a tortuous, tubular soft tissue structure in the abdomen. Abdominal ultrasound revealed a severely fluid‐distended uterus with a left uterine torsion, which was demonstrated by a "whirl sign." Emergency ovariohysterectomy surgically confirmed a 360° torsion of the left uterine horn with a fluid‐distended right uterine horn. Histopathology confirmed a diagnosis of pyometra, and the cat recovered uneventfully. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous Osseointegrated Implants (POIs) influence the load transfer path to the host bone. In turn, mechano-regulatory processes (strain adaptive bone remodeling) drive periprosthetic bone changes that influence implant stability and fixation outcome. These bone changes have not yet been reported for the Intraosseous Transcutaneous Amputation Prosthesis (ITAP) clinical trial. Objectives: This study will first standardize the zoning and reporting of periprosthetic bone change in POI radiographs. Second, it will retrospectively measure periprosthetic bone change from radiographs of 12 participants with an ITAP up to 11 years. Finally, the results will be qualitatively compared with those from participants with different POI designs. Materials and Methods: Twenty participants with unilateral transfemoral amputations received an ITAP in a 2-center UK clinical trial in either 2008/09 or 2013/14. Participant radiographs from one center were available (n = 12) over 11 years and have been collated and processed in a repeatable way. Transverse plane periprosthetic bone change measurements at 3 equidistant points along the implant stem were measured in AP and ML. Results: Total median bone growth in AP was double that in ML (57.6 mm and 31.12 mm, respectively). Median lateral and posterior bone change (1.44 mm and 1.09 mm) was greater than median medial and anterior (0.83 mm and −0.005 mm) bone changes, respectively. The greatest change in radial bone growth was observed distally and the least proximally. Conclusions: Bone changes were similar to other collared pressfit POIs in the literature. We demonstrate the influence of stem design and mechano-regulatory remodeling in stable fixation; however, additional influences on periprosthetic bone change were inferred from the results and further investigations are necessary. Clinical Relevance: To identify ITAP design features and fixations that minimize endosteal resorption, thus promoting implant stability and contributing to clinical guidelines for rehabilitation and future design and fixation choices. [ABSTRACT FROM AUTHOR]

Background: Posterior tibial slope (PTS) has been identified as a possible modifiable risk factor for anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) failure. However, the findings in the literature are inconsistent. This may be explained by several different reasons, including different measurement methods, differing definitions of ACLR failure, and possible inclusion of suboptimal films. Purpose: To compare PTS values obtained using plain radiographs (XR-PTS) in a young (≤21 years of age), skeletally mature patient population with those obtained using magnetic resonance imaging (MRI), as well as to quantify the number of suboptimal lateral knee radiographs obtained across an integrated health care system and determine the potential effect of including these radiographs on summary statistics of XR-PTS. Study Design: Case-control study; Level of evidence, 3. Methods: Skeletally mature adolescent and young adult patients ≤21 years of age were identified from the ACLR registry of Kaiser Permanente. The cases of concern were patients requiring revision ACLR. The controls were patients who had an ACLR and did not require a revision procedure. The XR-PTS measurements were made on plain radiographs by a single blinded reviewer. These results were compared with measurements obtained using MRI. The quality of each plain radiograph was evaluated by measuring posterior/distal femoral condylar overlap and length of tibial diaphysis captured on the radiograph. Summary statistics with and without inclusion of measurements made on suboptimal radiographs were calculated. Results: Of the initial 634 patients with ACLR (317 case-control pairs), 561 (88.5%) had radiographs available and were included for the analysis comparing radiograph to MRI slope measurements. For the evaluation of slope between case and control pairs with radiograph information available, there were 257 case-control pairs; there were 124 pairs when those with suboptimal radiographs were excluded. There was no difference in MRI-measured lateral tibial posterior slope or medial tibial posterior slope for the 257 case-control pairs with XR-PTS information and for the 124 pairs with optimal radiographs. XR-PTS in the revision cohort was significantly steeper than in the control group when suboptimal radiographs were included in the analysis. There was no difference when patients with suboptimal radiographs were excluded. PTS measurements made on plain radiographs were larger than those made on MRI. There was a poor correlation between measurements made using these 2 modalities (r = 0.22 for radiograph and medial PTS). Conclusion: This study did not find a significantly steeper XR-PTS in patients who had to undergo revision ACLR when suboptimal radiographs were not included in the analysis. The present study's results confirmed the findings from a previous study of the same patient population that used MRI. However, there was poor correlation between PTS measurements made using plain radiograph and MRI. [ABSTRACT FROM AUTHOR]

A radiographic gold standard to distinguish osteoporotic vertebral fractures (VFs) from nonosteoporotic VFs does not exist. Radiographic fracture-shaped vertebral deformity (FSVD) is common among young populations with normal bone strength. FSVD in an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely associated with compromised bone strength. For more severe grade deformities or when a vertebra is collapsed, experienced readers can make an osteoporotic VF diagnosis with a high degree of certainty. In milder cases, radiographic osteoporotic VF is often diagnosed based on a high probability rather than an absolute diagnosis. For older women, three nonadjacent minimal grade OLVFs (< 20% height loss), one minimal grade OLVF and one mild OLVF (≥ 20∼25% height loss), or one OLVF with ≥ 25% height loss meets the diagnosis of osteoporosis. For older men, a single OLVF with ≥ 33 to 40% height loss is insufficient to suggest the patient has osteoporosis. [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.

Background: Radiographs are a common diagnostic tool utilised during pre‐purchase examinations, yet differences surround their interpretation among equine veterinarians. Objectives: (1) To determine veterinarians' subjective impressions of a spectrum of radiographic abnormalities regarding suitability for purchase; (2) To determine how veterinarians' years in practice, primary discipline or board certification status influence their subjective impression of radiographic abnormalities, and (3) To determine how horses' discipline, current level of work (working at intended level vs. future prospect) and buyer intent (sell vs. retain ownership) influence veterinarians' subsequent recommendation. Study design: Worldwide electronic survey of veterinary professionals. Methods: Four radiographic series of navicular bones, tarsi, and stifles, representing varying degrees of pathological change (normal, mild, moderate and marked) were presented. Respondents (n = 211) graded their level of concern from 1 (no concern) to 10 (very concerned) based on the radiographs and case scenarios presented. Results: Overall, as the grade of pathological change increased for each anatomical location, so did the level of veterinarian concern, but a wide range of answers were submitted for all grades of pathology. Board certified practitioners had a higher level of concern over marked radiographic changes of the navicular bone for both western performance and English sport horses as well as prospect horses (mean = 7.2 vs. 6.1; P = 0.009; 95% CI for difference = [0.3, 2.0]). Board certified respondents had a lower level of concern over marked radiographic changes of the tarsus regardless of the performance status of the horse (mean = 7.1 vs. 8.0; P = 0.008; 95% CI for difference = [−1.5, −0.2]). Western performance horse practitioners had a lower level of concern over mild radiographic changes of the tarsus regardless of the performance status of the horse (mean = 3.3 vs. 4.2; P = 0.009; 95% CI for difference = [−1.6, −0.2]). Main limitations: Only one example of each pathological grade per anatomical region was presented. Conclusions: On survey radiographs, the perceived clinical relevance of radiographic abnormalities among equine practitioners differs widely, making purchase recommendations highly variable. [ABSTRACT FROM AUTHOR]

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).

Twelve clinical cases of goats having long bone fracture, presented at College in Jabalpur (India), were included in the study. These animals were randomly divided into two groups. Fracture segment of group I were immobilized by dynamic compression plate (DCP). In group II fracture immobilization was done as in group I and the gap between the fracture segments was filled by bone marrow mesenchymal stem cells (BMMSCs) seeded on ß-tricalcium phosphates scaffold. Fracture healing was evaluated on the basis of inflammation, exudation, pain, weight bearing and radiographic interpretation. Goat mesenchymal stem cells were established from bone marrow aspirates under aseptic conditions. Fibroblast like appearance of MSCs was observed after 3-4 days of seeding. Early cessation of inflammation, exudation and pain was observed in group II as compared to group I. Significant increase in weight bearing was observed from 7th day onwards in group II, while from 15th day onwards in group I. Complete weight bearing by all the goats was observed on 45th day in group II and 90th day in group I. Radiographic interpretation on 7th post-operative day revealed periosteal reaction on the fractured segment adjoining the fracture line in group II. On 30th post-operative day high density radiopaque area was visible at the fracture site in group II. Radiograph of 45th day in group II revealed more organized periosteal as well as intercortical callus, which reduced on 60th day, indicative of initiation of remodeling. On 90th day, homogenous bone with patent bone marrow was observed, indicative of completion of healing process in group II. [ABSTRACT FROM AUTHOR]

Standard plain film medical radiographs often form a valuable line of evidence to identify individuals in large‐scale fatality events. While commonly available, chest radiographs present a challenge that their analysis is somewhat more involved and complex than radiographic records of other body regions. For example, chest radiographs concern subtler morphological varieties of smaller anatomical features across a larger number of skeletal elements in contrast to frontal sinus comparisons that concern a large, (often) single, highly variable void within one bone. This does not detract from or discount chest radiographs as useful identification aids, but it does demand additional prerequisite skills in radiographic interpretation to ensure valid conclusions are attained. When subjects deviate from standardized antemortem (AM) radiographic positions and/or the image quality decreases, the complexity of a chest radiograph comparison is elevated. Generally, the current body of forensic radiographic comparison literature infrequently addresses these more complex circumstances. In this paper, we use real‐world radiographic comparison reference images from a military DVI repatriation context to illustrate these factors and outline some procedures that enable these complexities to be easily recognized and appropriately addressed at case examination. A report for an exemplar case that concurrently highlights multiple factors is presented. For novices learning radiographic comparison methods, this case review saliently demonstrates: (1) why the AM reference radiograph(s) drive(s) the radiographic comparison procedure; (2) why care should be taken for correct positioning of the cervicothoracic junction in postmortem radiography of chest elements. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed (I) to test the Willems’ dental age estimation method in different geographic samples of the Brazilian population, and (II) to propose a new model combining the geographic samples in a single reference table of Brazilian maturity scores. Materials and methods: The sample consisted of 5017 panoramic radiographs of Brazilian males (n = 2443) and females (n = 2574) between 6 and 15.99 years (mean age = 10.99 ± 2.76 years). The radiographs were collected from the Southeastern (SE) (n = 2920), Central-Western (CW) (n = 1176), and Southern (SO) (n = 921) geographic regions. Demirjian’s technique was applied followed by Willems’ method and the proposed Brazilian model. Results: Willems’ method led to mean absolute errors (MAE) of 0.79 and 0.81 years for males and females, respectively. Root mean squared errors (RMSE) were 1.01 and 1.03 years, respectively. The Brazilian model led to MAE of 0.72 and 0.74 years for males and females, respectively, and RMSE of 0.93 years for both sexes. The MAE was reduced in 70% of the age categories. Differences between regions were statistically (p < 0.05) but not clinically significant. Conclusion: The new model based on a combined population had an enhanced performance compared to Willems’ model and led to reference outcomes for Brazilians. Clinical relevance: Assessing patients’ biological development by means of dental analysis is relevant to plan orthopedic treatments and follow up. Having a combined-region statistic model for dental age estimation of Brazilian children contributes to optimal age estimation practices. [ABSTRACT FROM AUTHOR]

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]

Bone lesions are commonly encountered on radiographs. Often, bone lesions are incidental findings on radiographs obtained for trauma or joint pain. Because of the wide spectrum of pathology that can be present, it useful for anyone who evaluates bone radiographs to have an idea of how to approach these lesions. In this article, we provide 10 facts to help clinicians evaluate and risk stratify bone lesions. [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]

Purpose: Cervical total disc replacement (cTDR) has been established as an alternative treatment for degenerative cervical radiculopathy and myelopathy. While the rate of complications for cTDR is reasonably low, recent studies have focused on bone loss after cTDR. The purpose of this work is to develop a clinical management plan for cTDR patients with evidence of bone loss. To guide our recommendations, we undertook a review of the literature and aimed to determine: (1) how bone loss was identified/imaged, (2) whether pre- or intraoperative assessments of infection or histology were performed, and (3) what decision-making and revision strategies were employed. Methods: We performed a search of the literature according to PRISMA guidelines. Included studies reported the clinical performance of cTDR and identified instances of cervical bone loss. Results: Eleven case studies and 20 cohort studies were reviewed, representing 2073 patients with 821 reported cases of bone loss. Bone loss was typically identified on radiographs during routine follow-up or by computed tomography (CT) for patients presenting with symptoms. Assessments of infection as well as histological and/or explant assessment were sporadically reported. Across all reviewed studies, multiple mechanisms of bone loss were suspected, and severity and progression varied greatly. Many patients were reportedly asymptomatic, but others experienced symptoms like progressive pain and paresthesia. Conclusion: Our findings demonstrate a critical gap in the literature regarding the optimal management of patients with bone loss following cTDR, and treatment recommendations based on our review are impractical given the limited amount and quality evidence available. However, based on the authors' extensive clinical experience, close follow-up of specific radiographic observations and serial radiographs to assess the progression/severity of bone loss and implant changes are recommended. CT findings can be used for clinical decision-making and further follow-up care. The pattern and rate of progression of bone loss, in concert with patient symptomatology, should determine whether non-operative or surgical intervention is indicated. Future studies involving implant retrieval, histopathological, and microbiological analysis for patients undergoing cTDR revision for bone loss are needed. [ABSTRACT FROM AUTHOR]

Rapid adolescent growth is associated with an increased risk of disease and disease progression. This study assesses the reliability and validity of non-ionising B-mode ultrasound for the assessment of skeletal maturity (Risser Grade) and offers procedural guidelines for its use. Twenty-three female adolescents with primary-right-thoracic scoliosis (age: 13.8 (1.6) years) and twenty age-matched female control participants without scoliosis (age: 13.1 (1.8) years) were recruited. Skeletal maturity was determined from (i) a series of nine B-mode ultrasound images collected at sites equally spaced between the anterior and posterior superior iliac spines of the pelvis and (ii) clinical spine radiographs obtained as part of standard scoliosis care. Inter-rater reliability was assessed between a novice researcher and an experienced medical doctor. Concurrent-validity was assessed by comparing the location and degree of apophysis growth and fusion obtained via ultrasound with that obtained using radiograph Risser grading for scoliosis participants only. The inter - rater reliability of ultrasound Risser grading was strong [ICC(2,1): 0.99, p < 0.001]. High concurrent-validity was determined, with no difference in Risser grading identified between the radiograph and ultrasound grading methods (Wilcoxon signed-rank: Z = −1.93, p = 0.053). Ultrasound provides a reliable non-ionising alternative to the gold standard of Risser grading from radiographs to determine and monitor skeletal maturity. This study provides a detailed methodology for using ultrasound to assess skeletal maturity. Rapid adolescent growth is associated with an increased risk of disease and disease progression. Therefore, accurately determining and monitoring skeletal maturity in these adolescents is crucial. This study assesses the reliability and validity of non-ionising B-mode ultrasound for the assessment of skeletal maturity and offers procedural guidelines for its use. [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]

Several code‐based methods have been created for comparing the frontal sinus in skeletal identification scenarios. However, little is known regarding matched‐pair accuracy rates of these methods or how varying image modalities may affect these rates. The goals of this study were to validate the exclusion rates and to establish matched‐pair accuracy rates of two well‐cited coding methods, Cameriere et al. [23] and Tatlisumak et al. [24]. Additionally, individual variables were assessed for consistency in scoring between image modalities. Using a sample of U.S. African American, Native American, and European American females and males (n = 225), we examined individual variable scoring and string codes between two different image modalities (radiographs and CT‐based 3D models). Arcades showed poor scoring consistency between modalities (p < 0.001). Although exclusion rates were similar to those reported in the original studies (93%–96%), matched‐pair accuracy rates were low (13%–18%). None of the demographics (collection, sex, age, ancestry, and orientation) had an effect on the odds of a match. Interobserver and intraobserver analyses showed moderate to near‐perfect agreement for all variables except supraorbital cells, which had minimal to no agreement. Currently, we do not recommend the application of these frontal sinus coding methods independent of other supporting identification methods given low variable consistency and accuracy rates. Visual identification should still be used to include or exclude an identification when using the frontal sinus. [ABSTRACT FROM AUTHOR]

Preoperative supine radiographs are mandatory in the new adult idiopathic scoliosis (AdIS) classification. Supine radiographs are easily reproducible and highly predictive of side bending radiographs. However, few studies evaluated the use of supine radiographs in predicting postoperative curve correction after posterior spinal fusion (PSF) in AdIS. To investigate the use of supine and side bending (SB) radiographs in predicting postoperative curve correction in AdIS patients who underwent PSF. Retrospective study. A total of 93 AdIS patients who underwent PSF between 2022 and 2023 were included. Demographic data were age, gender, height, weight, body mass index (BMI), Risser grade, Lenke curve types and Cobb angles. Main outcome measures were preoperative and immediate postoperative Cobb angle (proximal thoracic [PT], main thoracic [MT] and thoracolumbar/lumbar [TL/L] curves), Supine Cobb angle and Flexibility rate (PT, MT and TL/L), and Correction rate (PT, MT and TL/L). Correlation study was performed between Supine Cobb angle vs postoperative Cobb angle for PT, MT and TL/L curves. A predictive formula was derived from the correlation plots. A total of 93 subjects were included in our study with a median age of 24.7 years and comprised of 80 females (86.0%). Preoperative Supine Cobb angle (r =0.835, r =0.881, r =0.767, p<.001) and preoperative SB Cobb angle (r =0.815, r =0.872, r =0.801, p<.001) showed similar strong positive correlation with postoperative PT, MT and TL/L Cobb angle, but preoperative Supine Cobb angle had slightly stronger correlation in PT and MT, whereas preoperative SB Cobb angle had stronger correlation in TL/L curve. Using the derived predictive formulae, there was a significant, strong, positive correlation between the predicted value and actual value of postoperative standing Cobb angle, (r=0.852, p<.001), with 71.0% of the patients had predicted postoperative Cobb angle from the supine radiographs within 5° of the actual value. Both supine radiographs and side bending radiographs had strong predictability of the postoperative Cobb angle for PT, MT and TL/L curves. In 71.0% of patients, the actual postoperative Cobb angle was within 5° of the predicted postoperative Cobb angle using the predictive formulae. [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.

The article focuses on the case of a 2-year-old German Shepherd dog with chronic hyporexia, vomiting, and hematochezia. Topics include the diagnostic process using blood work, radiographs, and ultrasound, the presence of a colonic stricture with associated perforation and adhesions, and the treatment decision leading to euthanasia after unsuccessful interventions.

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.

Background: The modified Gartland classification is the most widely accepted grading method of supracondylar humeral fractures among orthopedic surgeons and is relevant to identifying fractures that may require surgery. Objective: To assess the interobserver reliability of the modified Gartland classification among pediatric radiologists, pediatric orthopedic surgeons, and pediatric emergency medicine physicians. Materials and methods: Elbow radiographs for 100 children with supracondylar humeral fractures were retrospectively independently graded by two pediatric radiologists, two pediatric orthopedic surgeons, and two pediatric emergency medicine physicians using the modified Gartland classification. A third grader of the same subspecialty served as a tie-breaker as needed to reach consensus. Readers were blinded to one another and to the medical record. The modified Gartland grade documented in the medical record by the treating orthopedic provider was used as the reference standard. Interobserver agreement was assessed using kappa statistics. Results: There was substantial interobserver agreement (kappa = 0.77 [95% CI, 0.69−0.85]) on consensus fracture grade between the three subspecialties. Similarly, when discriminating between Gartland type I and higher fracture grades, there was substantial interobserver agreement between specialties (kappa = 0.77 [95% CI, 0.66−0.89]). The grade assigned by pediatric radiologists differed from the reference standard on 15 occasions, pediatric emergency medicine differed on 19 occasions, and pediatric orthopedics differed on 9 occasions. Conclusion: The modified Gartland classification for supracondylar humeral fractures is reproducible among pediatric emergency medicine physicians, radiologists, and orthopedic surgeons. [ABSTRACT FROM AUTHOR]

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]

Considering that different regions and races have different skeletal development stages, it is imperative to adopt appropriate standards for the age assessment of specific populations. The study aimed to identify a suitable method for knee epiphysis grading and evaluate the feasibility of age estimation based on magnetic resonance imaging (MRI) and X-ray in the Chinese population. MRI images and X-ray images of the knee were collected from 1018 volunteers and 833 volunteers aged 6–20 years old, respectively. A modified Kramer's classification method was used for the experiment. The minimum, maximum, mean, and standard deviation of radiography and MRI were defined for males and females in each age group. The ossification process in knee joints of the female volunteers occurred earlier compared to the male, and the X-ray grading was higher than that of the MRI during the same period. In the regression analysis, the R2 value with age of MRI was generally higher than the X-ray in males. MRI can be used as an effective, reliable, non-invasive, and non-radiation method for evaluating bone age. This study verified the feasibility of applying the knee epiphysis grading for forensic investigations in Chinese population. [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]

Stage-appropriate treatment of joint cartilage damage aims to improve joint function and slow down or prevent the development of osteoarthritis. A deep understanding of biomechanical influences has led to more precise preoperative analyses, allowing for individual adjustment of therapies. Patient-specific factors such as age and activity level are considered. Diagnostic procedures like detailed medical history and modern imaging are essential to determine the extent of damage and plan effective treatment accurately. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB)is endemic in various parts of the world and health-care practitioners should have high-end suspicion of TB knee in various cases of monoarthritis of the knee with atypical findings. We present a case of monoarthritis knee with an initial diagnosis being septic arthritis, with TB- cartridge-based nucleic acid amplification test negative for aspirated synovial fluid; followed by radiographic findings and synovial biopsy positive for chronic nonspecific inflammation with giant cells suggestive of TB, hence diagnosed as TB. • Painful swollen knee, with or without symptoms like fever, night sweats, weight loss. • TB knee diagnosis is complex, hindered by antibiotics, atypical presentations, and awareness gaps. • TB knee diagnosis relies on radiographs, fluid, nucleic acid tests, histopathology. [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]

Summary: We developed a new tool to assess the severity of osteoporotic vertebral fracture using radiographs of the spine. Our technique can be used in patient care by helping to stratify patients with osteoporotic vertebral fractures into appropriate treatment pathways. It can also be used for research purposes. Purpose: The aim of our study was to propose a semi-quantitative (SQ) grading scheme for osteoporotic vertebral fracture (OVF) on anteroposterior (AP) radiographs. Methods: On AP radiographs, the vertebrae are divided into right and left halves, which are graded (A) vertical rectangle, (B) square, (C) traverse rectangle, and (D) trapezoid; whole vertebrae are graded (E) transverse band or (F) bow-tie. Type A and B were compared with normal and Genant SQ grade 1 OVF, Type C and D with grade 2 OVF, and Type E and F with grade 3 OVF. Spine AP radiographs and lateral radiographs of 50 females were assessed by AP radiographs SQ grading. After training, an experienced board-certified radiologist and a radiology trainee assessed the 50 AP radiographs. Results: The height-to-width ratio of the half vertebrae varied 1.32–1.48. On lateral radiographs, 84 vertebrae of the 50 patients had OVFs (38 grade 1, 24 grade 2, and 22 grade 3). On AP radiographs, the radiologist correctly assigned 84.2%, 91.7%, and 77.2% and the trainee correctly assigned 68.4%, 79.2%, and 81.8% of grade 1, 2, and 3 OVFs, respectively. Compared with lateral radiographs, the radiologist had a weighted Kappa of 0.944 including normal vertebrae and 0.883 not including normal vertebrae, while the corresponding Kappa values for the trainee were 0.891 and 0.830, respectively. Conclusion: We propose a new semi-quantitative grading system for vertebral fracture severity assessment on AP spine radiographs. [ABSTRACT FROM AUTHOR]

Objective. (1) To compare the capacity to detect sacroiliac joint (SIJ) erosions and baseline-to-week 104 change in erosions between magnetic resonance imaging (MRI) and radiographs in recent-onset axial spondyloarthritis (axSpA); and (2) to compare treatment-discriminatory capacities of MRI and radiographic scores for erosion detection in patients receiving etanercept in the Effect of Etanercept on Symptoms and Objective Inflammation in Nonradiographic axSpA (EMBARK) trial vs controls in the DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes) cohort. Methods. Anonymized SIJ MRI and radiographs were assessed at patient and joint surface levels. Three readers evaluated MRI; 3 different readers evaluated radiographs. Final scores for comparison of radiographs and MRI for detection of erosions were assigned based on agreement of = 2 of 3 readers' assessments. Results. At baseline, discordance in erosion detection between imaging methods was more frequent for MRI erosions in the absence of radiographic erosions (48/224 [21.4%] patients) than for radiographic erosions in the absence of MRI erosions (14/224 [6.3%] patients; P < 0.001). After 104 weeks, a decrease in erosions was observed on MRI but not radiographs in 49/221 (22.2%) patients, and on radiographs but not MRI in 6/221 (2.7%) patients (P < 0.001). In the treatment-discriminant capacity analysis, the largest standardized differences between etanercept and control cohorts at week 104 were changes in Spondyloarthritis Research Consortium of Canada MRI erosion discrete score, changes in erosion average score, and meeting the modified New York criteria on radiographs, with unadjusted/adjusted Hedges G effect sizes of 0.40/0.50, 0.40/0.56, and 0.40/0.43, respectively. Conclusion. In recent-onset axSpA, SIJ erosions and erosion change were observed more frequently on MRI than radiography. The significance of interval improvement of MRI erosions warrants further research. [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]