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Hyde, E., and M. Hardy. "Patient centred care in diagnostic radiography (Part 3): Perceptions of student radiographers and radiography academics." Radiography 27, no. 3 (2021): 803–10. http://dx.doi.org/10.1016/j.radi.2020.12.013.
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Atutornu, Jerome, and Christopher M. Hayre. "A Survey Exploring Personalised Medicine amongst Radiography Academics within the United Kingdom." Journal of Medical Imaging and Radiation Sciences 51, no. 3 (2020): 443–50. http://dx.doi.org/10.1016/j.jmir.2020.05.013.
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Liu, Tiffany, Chia Wu, David Steinberg, et al. "Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients." Journal of Wrist Surgery 07, no. 02 (2017): 115–20. http://dx.doi.org/10.1055/s-0037-1606124.
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Background Obtaining wrist radiographs prior to surgeon evaluation may be wasteful for patients ultimately diagnosed with de Quervain tendinopathy (DQT). Questions/Purpose Our primary question was whether radiographs directly influence treatment of patients presenting with DQT. A secondary question was whether radiographs influence the frequency of injection and surgical release between cohorts with and without radiographs evaluated within the same practice. Patients and Methods Patients diagnosed with DQT by fellowship-trained hand surgeons at an urban academic medical center were identified retrospectively. Basic demographics and radiographic findings were tabulated. Clinical records were studied to determine whether radiographic findings corroborated history or physical examination findings, and whether management was directly influenced by radiographic findings. Frequencies of treatment with injection and surgery were separately tabulated and compared between cohorts with and without radiographs. Results We included 181 patients (189 wrists), with no differences in demographics between the 58% (110 wrists) with and 42% (79 wrists) without radiographs. Fifty (45%) of imaged wrists demonstrated one or more abnormalities; however, even for the 13 (12%) with corroborating history and physical examination findings, wrist radiography did not directly influence a change in management for any patient in this series. No difference was observed in rates of injection or surgical release either upon initial presentation, or at most recent documented follow-up, between those with and without radiographs. No differences in frequency, types, or total number of additional simultaneous surgical procedures were observed for those treated surgically. Conclusion Wrist radiography does not influence management of patients presenting DQT. Level of Evidence This is a level III, diagnostic study.
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Holliday, Charles L., Ryan Martin, and John A. Grant. "Comparing the Efficacy of Kneeling Stress Radiographs and Weighted Gravity Stress Radiographs to Assess Posterior Cruciate Ligament Insufficiency." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (2019): 2325967119S0030. http://dx.doi.org/10.1177/2325967119s00302.
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Objectives: Kneeling stress radiographs are commonly used to evaluate posterior cruciate ligament (PCL) laxity. Patients, however, report significant pain, and reproducibility is challenged due to its dependence on patient body weight distribution to produce posterior tibial displacement (PTD). Weighted gravity stress radiographs may offer better reproducibility and comfort than the kneeling technique, but its efficacy has not been studied. Hypothesis: weighted gravity radiographs will be more comfortable and produce similar PTD measurements when compared to the kneeling technique. Methods: Patients 18-70 years old with non-operatively or >6 months post-operatively treated PCL injuries (isolated or multi-ligamentous) were recruited from two academic level one trauma centers to undergo bilateral PCL stress radiographs. Exclusions: open/bilateral injuries, fractures. Patients underwent PCL stress radiographs by two randomly ordered methods. Kneeling stress views: patients knelt on padded scales (separate for each knee) with the padding distal to the tibial tubercle. Patients were verbally encouraged to place equal weight on both knees (scale outputs not visible to the patient). A digital radiography plate was placed between the legs to acquire bilateral lateral radiographs. Weighted gravity stress views: Patients lay supine with their hip and knee at 90°with the heel supported. A 20 lb weight was placed on the anterior tibia just distal to the tibial tubercle. A lateral radiograph was taken and then repeated on the contralateral leg. Images were anonymized and uploaded to PACS for measurement. Outcomes: side to side difference (SSD) in translation of the posterior tibial condyles relative to the posterior femoral condyles (primary outcome); patient-reported VAS knee pain (100 mm) during the radiographs; time required to acquire the images; patient preference for technique. Statistics: sample size = 31 patients to detect a 2 mm difference (α=0.05, power 80%, SD = 2.8 mm [Jung, 2006]). Paired t-tests were used to compare the SSD between the kneeling and weighted gravity methods, VAS pain, and time to complete the radiographs. Results: 40 patients (77.5% male, 34.5 ± 12.8yrs old, 65% left knee) were recruited. 42.5% had undergone PCL reconstruction. There was no difference between the two radiographic methods in the mean SSD (kneeling = 6.29 ± 4.58 mm, gravity = 6.82 ± 4.60 mm, p= 0.61). There was no difference in the total time required to perform the radiographs (kneeling = 307.3 s ± 140.5 s, gravity = 318.7 s ± 151.1 s, p= 0.73) or the number of radiographs taken to obtain acceptable images (kneeling = 3.6 ± 1.6, gravity = 3.7 ± 1.7, p= 0.73). The amount of weight placed on each knee during the kneeling views differed slightly but was not significant (affected = 21.5 ± 11.3 kg, unaffected = 26.1 ± 12.1 kg, p= 0.09). There was significantly less knee pain reported for the gravity views (kneeling = 31.8 ± 26.6, gravity = 4.0 ± 12.0, p < 0.0001). 94.6% of patients preferred the gravity method. Conclusion: Weighted gravity PCL stress radiographs should be considered for use in clinical practice as they produce similar posterior tibial translation values to the kneeling technique, do not rely on patient weightbearing, and provide significantly better patient comfort.
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Henry-Blake, C., K. Treadwell, S. Parmar, et al. "POS1400 A SYSTEMATIC REVIEW OF INTERNATIONAL GUIDELINES REGARDING THE ROLE OF RADIOGRAPHY IN THE DIAGNOSIS OF OSTEOARTHRITIS." Annals of the Rheumatic Diseases 80, Suppl 1 (2021): 983.1–983. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3117.
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Background:A substantial proportion of primary care osteoarthritis (OA) consultations are associated with an X-ray request (1,2). Uncertainty exists regarding the ability of radiography to improve a clinical OA diagnosis, and the over-use of radiography may lead to inappropriate referrals due to severe radiographic features that do not correlate with patients’ symptoms. Additionally, there are cost implications of unnecessarily imaging such a prevalent disease. As evidence questions the utility of routine radiography in OA, the extent to which radiography is supported by international guidelines is unknown.Objectives:To undertake a systematic review and narrative synthesis of UK and international guideline recommendations on the role of radiography in the diagnosis of OA.Methods:A systematic search of eleven electronic databases (including EMBASE, MEDLINE CINAHL, Epistemonikos and Guideline Central) and the websites of nine professional organisations (including NICE, Royal College of Radiologists (RCR), EULAR, and the American College of Radiology (ACR)) identified the most recent evidence-based guidelines produced by professional organisations on the role of imaging in OA. Guidelines not addressing the role of radiography in the diagnosis of OA were excluded, as were non-English and spinal OA guidelines. Each title was screened by one reviewer whilst each abstract and full text underwent dual screening. A single reviewer, using a standard proforma, undertook data extraction. Each guideline was independently appraised by two reviewers using the AGREE II tool. A narrative synthesis of the nature and consistency of OA radiographic recommendations was performed.Results:18 evidence-based OA guidelines published between 1998-2019 were included. These guidelines considered OA at any joint (n=8), or at the knee (n=3), hip (n=2), hand (n=2), wrist (n=1), foot (n=1), and ankle (n=1). Seven guidelines were produced by European organisations; four guidelines were produced by EULAR. Guidelines were targeted at general practitioners (n=11), radiologists (n=7), rheumatologist (n=4) and orthopaedic surgeons (n=3). Using the AGREE II tool, the identified guidelines scored highly on rigour of development (mean score 69%) but poorly on applicability (32%). All 18 guidelines recommended X-rays as the first-line modality, where imaging was indicated. A clinical diagnosis of OA without radiographic confirmation was recommended by all eleven guidelines produced by organisations represented general practitioners, with seven guidelines justifying this due to a poor correlation between radiographic features and clinical symptoms. Only three guidelines explicitly discouraged the routine use of radiography for the diagnosis of OA and only two guidelines reassured practitioners of a low probability of missing serious pathology when not routinely requesting radiographs. Guidelines produced by organisations representing radiologists were more supportive of radiography. The ACR recommended radiographic confirmation in patients suspected to have OA at the hand, wrist, hip, knee, ankle, and foot. Conversely, the RCR recommended radiographic confirmation in patients suspected to have OA at the hand, feet, and hip, but not the knee.Conclusion:Differences in guideline recommendations on the utility of radiography in OA appear related to country/region, professional organisation, and joint. The use and utility of radiography in OA may need to be reviewed in light of a shift towards remote consultations, a change that has been accelerated by COVID-19 in many countries.References:[1]Yu D, Jordan K, Bedson J, Englund M, Blyth F, Turkiewicz A et al. Population trends in the incidence and initial management of osteoarthritis: age-period-cohort analysis of the Clinical Practice Research Datalink, 1992–2013. Rheumatology. 2017;56(11):1902-1917.[2]Brand C, Harrison C, Tropea J, Hinman R, Britt H, Bennell K. Management of Osteoarthritis in General Practice in Australia. Arthritis Care & Research. 2014;66(4):551-558Acknowledgements:JJE is funded by an Academic Clinical Lectureship from the National Institute for Health Research (NIHR) for this research project (CL-2016-10-003). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.Disclosure of Interests:None declared
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Žunić, Ljubica. "The Legal Framework for Academic Professional Development for Radiographers in Higher Education." Medicine, Law & Society 12, no. 1 (2019): 65–84. http://dx.doi.org/10.18690/mls.12.1.65-84.2019.
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Technology has changed the world of radiography, setting the request for development and promotion of radiography occupation. This article focuses on key factors of education for radiologic technologist / radiographer. The important role of EFRS in promoting and developing advanced educational standards and qualifications for radiographers is elaborated. Harmonization and development of radiographer’s profession following technological development considers cooperation among educational institutions, employers and professional bodies, within the framework of European and national legislation. Society should provide the conditions for further education. Obtaining a master's and / or doctoral degree, and integration in teaching and research activities, helps transform radiographers into leadership roles within their departments.
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Razi, Tahmineh, and Alireza Sighari Deljavan. "The Comparison of learning radiographic extraoral landmarks through two methods." Advances in Bioscience and Clinical Medicine 5, no. 1 (2017): 16. http://dx.doi.org/10.7575/aiac.abcmed.17.05.01.03.
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Objectives: The long time interval between teaching anatomy courses to students and the courses on extraoral radiographs results in forgetting the location of radiographic anatomic landmarks without any retention; therefore, it is necessary to use other educational techniques due to short duration of educational courses. To this end, the present study was undertaken to evaluate the effect of a combination of lectures and computer techniques on teaching extraoral radiographs to undergraduate dental students. Methods: In the present interventional study, dental students entering the university in the same year (referred to as one class) were divided into two groups; one group received conventional teaching and one group received combinational teaching technique. Students entering the next year were taught using the same teaching techniques. The results were compared between groups and classes. Results: Comparison of the results of the first test between the two classes showed significant differences between the two groups (P<0.001). Comparison of the results of the second test between the two classes revealed no significant differences in the conventional method (P=0.76); however, the combination technique exhibited significant differences (P=0.006). In the first test, comparison of the two techniques in the students entering the university in 2006 showed no significant differences (P=0.055); however, students entering the university in 2007 exhibited significant differences (P=0.03). In the second test, comparison of the two techniques in both classes revealed significant differences (P<0.001).Conclusion: If more time is allocated to the combination technique, learning improves even in a short time. This method can replace the conventional method to teach interpretation of extraoral radiographs after evaluation of academic level of the studies. Keywords: Computer-assisted learning; extra-oral radiography; lecture;
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Caughman, Alexander, and Christopher E. Gross. "Radiographic Characterization of Midfoot and Transverse Tarsal Joint Osteoarthritis." Foot & Ankle Orthopaedics 5, no. 4 (2020): 2473011420S0015. http://dx.doi.org/10.1177/2473011420s00157.
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Category: Midfoot/Forefoot Introduction/Purpose: The burden of midfoot arthritis is staggering. Foot osteoarthritis affects over 16% of all adults over the age of 50, interfering with activities of daily living and leisure. Non-operative management often culminates in fluoroscopic guidance injections. Its management is troublesome for surgeons as conservative treatment is maximized because its surgical solution is oftentimes fraught with nonunions and other complications. The purpose of this study was to see how well surgeons are able to predict midfoot and transverse tarsal joint osteoarthritis on x-rays as it compares to CT and MRI scans. Methods: We reviewed the records of 117 patients (146 feet) with a diagnosis code of midfoot osteoarthritis who were treated from 2015 to 2019 at an academic medical center by a single surgeon. The mean age was 63.2 +- 10.7 years. The average BMI was 31.2 +- 6.4. Each of those patients had both plain radiographs and either a CT or MRI scan. Patients had weight-bearing anteroposterior and lateral radiographs according to a standardized protocol. Radiographs and advanced images were graded separately for the presence of joint space narrowing, subchondral cysts, and other signs of arthritis. We then compared how frequently a radiograph predicted an arthritic midfoot or transverse tarsal joint as compared to a CT scan or MRI using a paired t test. Results: The most common joints affected by arthritis were the 2nd TMT (83.5% by X-ray; 88.4% by CT) and 3rd TMT (71.9% by X-ray; 68.4% by CT). Advanced imaging showed a significantly higher rate of arthritis in the 1st, 4th, and 5th TMT as compared to X-rays. Only 20.2% of patients’ radiographs had a direct correlation with their CT scan. A CT scan showed one or two more affected joints by 23.6% and 17.6 % respectively, and rarely showed one or two less joints affected by arthritis, 6.8% and 0.6% respectively. Based on this data, a radiograph’s sensitivity and specificity vary wildly-from 86.0% and 57.8%, respectfully in the 3rd TMT to 43.8% and 96.0%, respectfully in the 1st TMT. Conclusion: Radiographs vary quite drastically in their sensitivities and specificities in diagnosing osteoarthritic joints in the midfoot and transverse tarsal joints. If intending to treat midfoot osteoarthritis with fluoroscopic injections, we recommend not relying on plain radiographs, but advanced imaging.
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Cohen, Mervyn D., Richard Markowitz, Jeanne Hill, Walter Huda, Paul Babyn, and Bruce Apgar. "Quality assurance: a comparison study of radiographic exposure for neonatal chest radiographs at 4 academic hospitals." Pediatric Radiology 42, no. 6 (2011): 668–73. http://dx.doi.org/10.1007/s00247-011-2290-1.
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Trakimas, Danielle R., Elliott D. Kozin, Iman Ghanad, Sam R. Barber, Hugh Curtin, and Aaron K. Remenschneider. "Precurved Cochlear Implants and Tip Foldover: A Cadaveric Imaging Study." Otolaryngology–Head and Neck Surgery 158, no. 2 (2017): 343–49. http://dx.doi.org/10.1177/0194599817738978.
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Objective This study aims to define a reliable protocol for radiographic identification of placement and tip foldover of newly designed precurved and straight electrodes. Study Design Prospective imaging study. Setting Academic institution. Methods Three models of cochlear implants (Cochlear, MED-EL, and Advanced Bionics) were inserted into fresh cadaveric specimens (n = 2) in 3 configurations (normal positioning in the scala tympani, intracochlear tip foldover, and placement into the vestibular system) for a total of 9 implant scenarios. Specimens were imaged with plain radiography in Stenvers projection, as well as by high-resolution computed tomography. Results Electrode placement and presence or absence of electrode tip foldover were easily identified in all 9 scenarios on plain radiography based on the described technique. Each was confirmed with high-resolution computed tomography. Plain film temporal bone images of new electrode designs with proper and improper placement are provided for reference. Conclusion A defined protocol for intraoperative plain film radiography allowed for reliable imaging of 3 newly designed cochlear implant electrodes and immediate identification of extracochlear placement and tip foldover. Findings may be used for intraoperative confirmation of electrode array placement.
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DeSimone, Mia S., Ariadne K. DeSimone, Ellen X. Sun, et al. "Cross-Residency Radiologic/Pathologic Correlation Curriculum: Teaching Correlation of Surgical Specimens With Imaging." Academic Pathology 7 (January 1, 2020): 237428952093925. http://dx.doi.org/10.1177/2374289520939258.
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The College of American Pathologists expects pathologists to attain competency in radiologic/pathologic correlation, including correlation of histopathologic findings with imaging findings. While pathology residents appreciate the importance of radiologic/pathologic correlation, their lack of experience and confidence in interpreting imaging studies deters them from obtaining specimen radiographs and reviewing preoperative imaging studies. Formal training in this domain is lacking. A cross-residency curriculum was developed to help pathology residents build basic skills in the correlation of surgical specimens with preoperative imaging and specimen radiographs. Didactic sessions were prepared by 3 pairs of radiology and pathology residents with guidance from radiology and pathology attendings in the subspecialty areas of breast, musculoskeletal, and head and neck. The authors describe the development, implementation, and assessment of the curriculum. A total of 20 pathology residents attended the sessions, with 7 completing both the pre- and postintervention surveys. These residents gained confidence in their ability to interpret specimen radiographs and to select specimens to evaluate with radiography. They gained an appreciation of the importance of collaboration with radiologists in evaluating specimens and of viewing preoperative imaging studies to guide gross examination and dissection. They reported obtaining specimen radiographs and viewing preoperative imaging studies more frequently after attending the sessions. Innovative solutions such as this cross-residency educational initiative offer a potential solution to fulfill the radiologic/pathologic correlation competency standard for pathology residents and may be replicable by other residency programs and academic institutions.
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Lander, Sarah, Julie Michels, Anne Brayer, et al. "PEDIATRIC ORTHOPEDIC RADIOGRAPH REDUCTION: A QUALITY IMPROVEMENT INITIATIVE." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (2020): 2325967120S0014. http://dx.doi.org/10.1177/2325967120s00149.
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Background: Children are more vulnerable to ionizing radiation which increases health risks later in life including cancer. An interdepartmental team developed an algorithm to guide providers ordering extremity radiographs in pediatric patients with musculoskeletal (MSK) injuries. Purpose: Reduce unnecessary pediatric radiation/extremity radiographs through development and implementation of an interdepartmental designed algorithm. Determine utility, safety, and efficacy of the algorithm through retrospective and prospective analysis. Methods: Our study was performed at an academic pediatric trauma center. An interdepartmental committee including pediatric orthopedic surgery, emergency medicine, trauma, and radiology providers created a MSK injury imaging algorithm (Figure 1). We retrospectively validated the algorithm for efficacy and safety through chart review of pediatric patients seen in the ED with MSK extremity injury, identified through CPT code, from 6/24/2016 through 8/31/2016. We determined the number of extra radiographs per patient and identified if injuries would be missed utilizing our protocol. After retrospective validation, guideline implementation was undertaken through multidisciplinary education. The imaging guideline was prospectively implemented in the pediatric ED from 6/24/2018 through 8/31/2018. We continued to prospectively evaluate through selecting one week every month over the following eight months to determine sustainability of the implemented algorithm. Results: Our interdepartmental team in 2016 developed a pediatric MSK radiograph protocol (Figure 1). A retrospective chart and radiograph review of 295 pediatric patients between 6/24/2016 through 8/31/2016 was analyzed correlating physical examination to appropriate radiographs. Utilizing the protocol, the review revealed an average of 2.75 extra radiographs per patient. No injuries were missed. Providers including orthopedic and emergency medicine attendings, mid-levels, and residents were educated through meetings, emails, and having the protocol posted and easily accessible. Our protocol was implemented 6/24/18 and underwent prospective enrollment and review through 8/31/18 which revealed a reduction to 0.72 radiographs per patient (P-value <0.001) (Figure 2). Eight month follow up revealed a sustainable reduction in extra radiographs per patient (Figure 3). Conclusion: Reduction of unnecessary radiation to pediatric patients with MSK extremity injuries was accomplished through development and implementation of a safe and effective imaging algorithm. The multidisciplinary approach combined with widespread education of pediatric providers improved buy-in driving a sustainable system improvement. [Figure: see text][Figure: see text][Figure: see text]
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Castle, A. "Radiography: nature of knowledge and academic tribe." Radiography 6, no. 4 (2000): 261–68. http://dx.doi.org/10.1053/radi.2000.0282.
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Knapp, K. M., C. Wright, H. Clarke, S. J. McAnulla, and J. M. Nightingale. "The academic radiography workforce: Age profile, succession planning and academic development." Radiography 23 (September 2017): S48—S52. http://dx.doi.org/10.1016/j.radi.2017.05.012.
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Burks, S. Shelby, Juan S. Uribe, John Paul G. Kolcun, et al. "Proximal fusion constructs in minimally invasive scoliosis surgery are successful without interbody or intertransverse fusion." Journal of Neurosurgery: Spine 31, no. 6 (2019): 851–56. http://dx.doi.org/10.3171/2019.5.spine19192.
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OBJECTIVEMinimally invasive techniques are increasingly used in adult deformity surgery as surgeon familiarity improves and long-term data are published. Concerns raised in such cases include pseudarthrosis at levels where interbody grafts are not utilized. Few previous studies have specifically examined the thoracolumbar component of long surgical constructs, which is commonly instrumented without interbody or intertransverse fusion.METHODSA retrospective analysis was performed on all patients who underwent hybrid minimally invasive deformity corrections in two academic spine centers over a 9-year period. Inclusion criteria were at least 2 rostral levels instrumented percutaneously, ranging from T8 to L1 as the upper end of the construct. Fusion assessment was made using CT when possible or radiography. Common radiographic parameters and clinical variables were assessed pre- and postoperatively.RESULTSA total of 36 patients fit the inclusion criteria. Baseline characteristics included a 1:1.8 male/female ratio, average age of 65.7 years, and BMI of 30.2 kg/m2. Follow-up imaging was obtained at a mean of 35.7 months. The average number of levels fused was 7.5, with an average of 3.4 instrumented percutaneously between T8 and L1, representing a total of 120 rostral levels instrumented percutaneously. Fusion assessment was performed using CT in 69 levels and radiography in 51 levels. Among the 120 rostral levels instrumented percutaneously, robust fusion was noted in 25 (20.8%), with 53 (44.2%) exhibiting some evidence of fusion. Pseudarthrosis was noted in 2 rostral segments (1.7%). There were no instances of proximal hardware revision. Eight patients exhibited radiographic proximal junctional kyphosis (PJK; 22.2%), none of whom underwent surgical intervention.CONCLUSIONSIn the present series of adult patients with scoliosis undergoing thoracolumbar deformity correction, rostral segments instrumented percutaneously have a very low rate of pseudarthrosis, with radiographic evidence of bone fusion occurring in more than 60% of patients. The rate of PJK was acceptable and similar to other published series.
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Staats, Kevin, Ilse-Gerlinde Sunk, Claudia Weidekamm, et al. "Hand X-ray examination in two planes is not required for radiographic assessment of hand osteoarthritis." Therapeutic Advances in Musculoskeletal Disease 12 (January 2020): 1759720X2093493. http://dx.doi.org/10.1177/1759720x20934934.
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Aims: Radiographic imaging is essential in the diagnosis of hand osteoarthritis (HOA); however, it is unknown whether a multiplanar examination would add essential information to dorso-palmar (dp) views alone. This study evaluated whether an additional radiographic view would aid clinicians in the diagnostic process of HOA. Methods: The dp radiographs of both hands from 159 HOA patients were assessed according to the scores described by Kellgren and Lawrence (K/L). In oblique view images, structures similar to classic ostophytes (OPs) were found, namely bony proliferations on the dorsal and/or ventral margins of joints, and were documented as dorsal/ventral OPs (dvOPs). Function and pain were assessed by applying standardised read-out systems. Logistic regression analysis and Mann–Whitney tests were implemented. Results: The presence of dvOPs was associated with the degree of joint damage; however, dp views were sufficient to estimate radiographic changes. Only a few joints showed dvOPs as the only structural alteration; nevertheless, in almost all cases, classical radiographic OA changes were found in dp views of other joints of the same or the contralateral hand. The presence of dvOPs did not affect joint function or pain according to established scores, but was associated with radiographic progression in distal interphalangeal joints. Conclusion: This is the first study to confirm that additional radiographic planes, oblique/lateral views, are not necessary in the diagnostic process in HOA in daily clinical practice. Nevertheless, the presence of dvOPs reflect more severe joint damage and is associated with radiographic progression in HOA; hence, oblique/lateral views could be a useful tool for academic purposes.
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Yeung, Andy Wai Kan, and Natalie Sui Miu Wong. "Reject Rates of Radiographic Images in Dentomaxillofacial Radiology: A Literature Review." International Journal of Environmental Research and Public Health 18, no. 15 (2021): 8076. http://dx.doi.org/10.3390/ijerph18158076.
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This report surveyed the image reject rates of intra-oral, extra-oral, and cone-beam computed tomography (CBCT) imaging in the academic literature. PubMed, Web of Science, and Scopus databases were queried in mid-April 2021. Manual screening of the reference lists of the identified publications was performed to identify papers missed from the database search. All publications returned by the searches were initially included. Exclusion criteria included irrelevance, no reporting of reject rate, no access to the article, and not original article. The total number of images and the number of rejects were recorded for each type of radiographic images. Factors and commonest errors associated with the rejects were recorded. Twenty-six original articles were identified and reviewed. The average reject rate was 11.25% for bitewings, 16.38% for periapicals, 4.10% for panoramics, 6.08% for lateral cephalography, and 2.77% for CBCT. Positioning error and patient movement were two common reasons for the rejects. The average reject rates computed from data pooled across studies should form the reference values for quality assurance programs to follow. Future reject analysis studies should report more radiographic parameters such as type of collimation for intra-oral radiography and patient posture for CBCT.
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Oflazoglu, Kamilcan, Suzanne C. Wilkens, Hinne Rakhorst, Kyle R. Eberlin, David Ring, and Neal C. Chen. "Postoperative Dorsal Proximal Interphalangeal Joint Subluxation in Volar Base Middle Phalanx Fractures." Journal of Hand and Microsurgery 12, no. 01 (2019): 32–36. http://dx.doi.org/10.1055/s-0039-1697063.
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Abstract Introduction This study was designed to assess factors associated with postoperative dorsal proximal interphalangeal (PIP) joint subluxation after operative treatment of volar base middle phalanx fractures. Our second purpose was to study the association between postoperative dorsal subluxation with postoperative arthritis. Materials and Methods We identified 44 surgically treated volar base PIP joint fractures with available pre- and postoperative radiographs between 2002 and 2015 at two academic medical systems with a median follow-up of 3.5 months. Demographic, injury, radiographic, and treatment data that might be associated with postoperative dorsal subluxation were collected. Three hand surgeons independently assessed subluxation and arthritis on radiographs. Bivariate analysis was performed to analyze our two study purposes. Results Six of 44 (14%) had postoperative dorsal subluxation after initial surgery. Bivariate analysis showed no factors with statistically significant association with postoperative subluxation, assessed independently by three hand surgeons on radiographs. Fifty per cent of the joints with postoperative arthritis had postoperative subluxation compared with 21% of joints without postoperative subluxation. No significant association was found between postoperative dorsal subluxation with postoperative arthritis. Conclusion The association of persistent subluxation and early arthrosis in dorsal PIP joint fracture dislocations needs further study. At this time, it is unclear in what ways persistent subluxation or arthrosis affects the rate of reoperation. Level of Evidence This is a therapeutic level IV study.
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Michael Sunday Okpaleke, Christopher Chukwuemeka Ohagwu, Chigozie Ivor Nwobi, Michael Promise Ogolodom, Victor Kelechi Nwodo, and Uche Nathaniel Eja-Egwu. "Effects of the COVID-19 pandemic on radiography education in Nnamdi Azikiwe University, Nigeria." International Journal of Science and Research Archive 3, no. 1 (2021): 082–92. http://dx.doi.org/10.30574/ijsra.2021.3.1.0104.
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COVID-19 pandemic shutdown of tertiary institutions in Nigeria and globally following the lockdown of socio-economic activities. There is paucity of data on the effects of the pandemic on Radiography education in Nigerian universities especially in Nnamdi Azikiwe University (NAU) Nnewi campus. This prospective cross - sectional study was carried out using a structured questionnaire. One hundred and twenty- five questionnaires were distributed by the researcher to students, academic and non-academic staff of the department of Radiography, NAU, and one hundred was retrieved thereafter. Descriptive and inferential statistics were used for data analysis using statistical package for social sciences (SPSS) version 23 at 5% level of significance. The major effects of the COVID-19 pandemic on Radiography education in NAU were poor access to education financing (97%), poor attendance to lectures (91%), poor academic performance after the lockdown (85%), better attitude to infection control (81%), disruption of academic calendar (88%), the rushing of many lectures over a short time and low assimilation/understanding among students (75%), the predominance of physical classroom lectures especially among undergraduates (55%), promoted online lectures especially among postgraduate students (45%), better hygiene culture (35%, 0.00076 = p < 0.05, adjusted α = 0.0032) ) and loss of interest in education (27.5%). However, only the enthronement of better hygiene culture had significant effects on Radiography education (p = 0.00076). The study concludes that the only significant and positive effect of COVID-19 pandemic on Radiography education in NAU was the enthronement of better hygiene culture.
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Kofler, Johann. "Surgical treatment of septic arthritis of proximal joints and treatment of bone sequestra in cattle." Revista Acadêmica: Ciência Animal 15, Suppl 2 (2017): 67. http://dx.doi.org/10.7213/academica.15.s02.2017.a07.
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Septic arthritis is a common cause of severe lameness in cattle, most commonly the distal interphalangeal joint is involved. Septic arthritis of proximal joints (fetlock, carpal, tarsal, stifle etc.) in cattle had been reported on a much lower frequency. Septic arthritis is caused by direct inoculation of bacteria into the joint (primary infection) or from spread of periarticular infection (secondary infection) or by haematogenous spread. Traumatic arthritis is not as common as septic arthritis and involves predominantly the larger proximal joints. Up to now, the diagnosis of bovine arthritis has been based on careful clinical examination, radiography, arthrocentesis and macroscopic, cytological and microbiological examination of the synovial sample.However, during the last 20 years, ultrasonography has proved to be of paramount importance for soft tissue differentiation in bovine orthopedics, adding important information to the clinical findings.
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Fraenkel, Liana, Lisa Suter, Lawrence Weis, and Gillian A. Hawker. "Variability in Recommendations for Total Knee Arthroplasty Among Rheumatologists and Orthopedic Surgeons." Journal of Rheumatology 41, no. 1 (2013): 47–52. http://dx.doi.org/10.3899/jrheum.130762.
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Objective.The most rapidly growing population of patients undergoing total knee arthroplasty (TKA) is under the age of 65. The objective of our study was to gain insight into the factors influencing physicians’ recommendations for persons in this age group with moderate osteoarthritis (OA).Methods.Rheumatologists and orthopedic surgeons attending national meetings were asked to complete a survey including a standardized scenario of a 62-year-old person with knee OA who has moderate knee pain limiting strenuous activity despite medical management. We used an experimental 2 × 2 × 2 design to examine the effects of sex, employment status, and severity of radiographic OA on physicians’ recommendations. Each physician was asked to rate a single scenario.Results.The percentage of physicians recommending TKA varied from 30% to 55% for scenarios describing a patient with mild radiographic OA, and from 39% to 71% for scenarios describing a patient with moderate radiographic OA. Surgeons were less likely to recommend TKA for women compared to men of the same age, employment status, symptom severity, and functional status, and radiographs. Rheumatologists practicing in academic settings were more likely to recommend TKA compared to those practicing in nonacademic settings, and American surgeons were more likely to recommend TKA compared to their European counterparts.Conclusion.Orthopedic surgeons and rheumatologists vary significantly in their recommendations for patients with moderate knee pain and functional limitations. Both patient and physician characteristics influence physicians’ recommendations, and rheumatologists and orthopedic surgeons display different patterns of decision making.
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Sanderud, Audun. "Publication activities among the radiography sector in Norway." Radiography Open 1, no. 1 (2014): 4. http://dx.doi.org/10.7577/radopen.1201.
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Aim To give an overview over journals chosen for publication by the radiography field. Background Traditionally, the professional development of radiography was dominated by other disciplines, e.g. radiology, physics, sociology and nursing. The move into the higher education sector led radiographers be additionally encouraged in research activities. Evidence based practice is an approach to clinical problem solving and health care provision based on "good evidence". Research papers are an important part. Till date, the publication activities and choose of journals among Norwegian radiography staffs have been unknown. Conclusions The wide list of journals chosen illustrates a broad underpinning of radiography. Radiography science in Norway has already shown considerable development and achieved many substantial and structural criteria set for independent academic disciplines.
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Ahonen, Sanna-Mari, and Eeva Liikanen. "Development and challenges of a new academic discipline, radiography science." European Journal of Radiography 1, no. 3 (2009): 81–84. http://dx.doi.org/10.1016/j.ejradi.2009.10.001.
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Hoogeveen, Reinier C., Marinka L. F. Hol, Bradley R. Pieters, et al. "An overview of radiological manifestations of acquired dental developmental disturbances in paediatric head and neck cancer survivors." Dentomaxillofacial Radiology 49, no. 3 (2020): 20190275. http://dx.doi.org/10.1259/dmfr.20190275.
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Objectives: In paediatric cancer survivors treated with chemotherapy and radiotherapy therapy, late effects on dental development are quite common. Oral radiologists are not familiar with the radiographic images of these specific dental consequences of chemotherapy and radiotherapy. With the goal of educating colleagues, to raise awareness of the needs of survivors, and to identify directions for future research, we present dental radiographs of survivors treated for head and neck rhabdomyosarcoma with chemotherapy and radiotherapy. Also, based on the survivors reviewed, a radiographic inventory of commonly found late dental developmental effects seen in conjunction with treatment is presented. Methods: Panoramic radiographic findings of five illustrative cases are presented, from a group of 42 survivors of head and neck rhabdomyosarcoma treated at the Academic Medical Center Amsterdam, The Netherlands over the past 25 years. Results: Five cases showing dental developmental disorders are presented. These cases show an association of the location of the radiation field and the developmental stage of the teeth with the severity of the effect on dental development. We also report an inventory of severe and moderate effects of chemotherapy and radiotherapy on the development of molars and anterior teeth. Conclusions: This paper presents five cases and a radiographic inventory to illustrate disturbances of dental development associated with chemotherapy and radiotherapy in children. Medical and dental professionals involved in the treatment of cancer survivors are relatively unaware of the dental consequences of radiation therapy and the age dependency of specific regional effects. These effects can be severe, with great impact on quality of life. Further research in this area could help improve planning of radiation therapy for children, potentially preventing or limiting dental or maxillofacial sequelae.
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Kridiotis, Carol A., Johan Bezuidenhout, and Jacques Raubenheimer. "Selection criteria for a radiography programme in South Africa: Predictors for academic success in the first year of study." Health SA Gesondheid 21 (October 11, 2016): 206–13. http://dx.doi.org/10.4102/hsag.v21i0.955.
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Background: Selection criteria used to admit students to a radiography programme at the Central University of Technology (CUT) included academic criteria, as well as the General Scholastic Aptitude Test (GSAT) and Self-directed Search (SDS) Questionnaire.Aims and objectives: The aim of the study was to identify which selection criteria were predictors of academic success in the first year of study. As a four year Bachelor's degree in Radiography (480 credits) was to replace the three year National Diploma (NDip) in Radiography (360 credits), selection criteria would come under review.Design and method: Data from 130 students were gathered in a retrospective quantitative study. Data were edited, categorised and summarised. A statistical analysis was undertaken to identify which selection criteria predicted academic success in the first year of study.Results: Statistics showed that the matriculation Admission Points Score (National Senior Certificate/NCS APS) and core matriculation subject results in Mathematics, Physical Sciences and English were adequate predictors for first-year academic success, and the subjects Life Sciences for the NSC and Biology for the Senior Certificate (SC), showed strong predictive values for first-year academic success. According to the statistical analysis, the GSAT and SDS Questionnaire did not contribute any significant information which could predict academic success.Conclusion: Matriculation marks and NSC APS were adequate predictors for academic success, with a focus on Life Sciences or Biology marks as the strongest predictor. The usefulness of the GSAT and SDS Questionnaire could be questioned, and a recommendation was made to replace these tests with alternative student selection methods.
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Beason, Austin M., Ryan J. Koehler, Rosemary A. Sanders, et al. "Surgeon Agreement on the Presence of Pathologic Anterior Instability on Shoulder Imaging Studies." Orthopaedic Journal of Sports Medicine 7, no. 8 (2019): 232596711986250. http://dx.doi.org/10.1177/2325967119862501.
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Background: In the setting of anterior shoulder instability, it is important to assess the reliability of orthopaedic surgeons to diagnose pathologic characteristics on the 2 most common imaging modalities used in clinical practice: standard plain radiographs and magnetic resonance imaging (MRI). Purpose: To assess the intra- and interrater reliability of diagnosing pathologic characteristics associated with anterior shoulder instability using standard plain radiographs and MRI. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patient charts at a single academic institution were reviewed for anterior shoulder instability injuries. The study included 40 sets of images (20 radiograph sets, 20 MRI series). The images, along with standardized evaluation forms, were distributed to 22 shoulder/sports medicine fellowship–trained orthopaedic surgeons over 2 points in time. Kappa values for inter- and intrarater reliability were calculated. Results: The overall response rate was 91%. For shoulder radiographs, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.49), estimate of glenoid lesion surface area (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.35), and estimate of Hill-Sachs surface area (κ = 0.50). Intrarater agreement was moderate for radiographs (κ = 0.48-0.57). For shoulder MRI, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.44), glenoid lesion surface area (κ = 0.35), Hill-Sachs lesion (κ = 0.33), Hill-Sachs surface area (κ = 0.28), humeral head edema (κ = 0.41), and presence of a capsulolabral injury (κ = 0.36). Fair agreement was found for specific type of capsulolabral injury (κ = 0.21). Intrarater agreement for shoulder MRI was moderate for the presence of glenoid lesion (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.52), estimate of Hill-Sachs surface area (κ = 0.50), humeral head edema (κ = 0.51), and presence of a capsulolabral injury (κ = 0.53), and agreement was substantial for glenoid lesion surface area (κ = 0.63). Intrarater agreement was fair for determining the specific type of capsulolabral injury (κ = 0.38). Conclusion: Fair to moderate agreement by surgeons was found when evaluating imaging studies for anterior shoulder instability. Agreement was similar for identifying pathologic characteristics on radiographs and MRI. There was a trend toward better agreement for the presence of glenoid-sided injury. The lowest agreement was observed for specific capsulolabral injuries.
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Gqweta, Ntokozo. "Poor academic performance: A perspective of final year diagnostic radiography students." Radiography 18, no. 3 (2012): 212–17. http://dx.doi.org/10.1016/j.radi.2012.04.002.
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De Hooge, M., A. Ishchenko, S. Steinfeld, et al. "OP0055 MINIMAL RADIOGRAPHIC DAMAGE OF SACROILIAC JOINTS DETECTED IN PSORIATIC ARTHRITIS PATIENTS." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 37.1–37. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2392.
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Background:Psoriatic arthritis (PsA) is an inflammatory joint disease that is traditionally included in the Spondyloarthritis (SpA) spectrum. Prevalence and impact of axial involvement in PsA remains understudied but increasingly affects treatment decisions.Objectives:The first step, in this multi-purpose radiographic study, is to report on baseline radiographic damage of the sacroiliac joints (SIJ) in PsA patients from a prospective multicentre cohort study in private and academic rheumatology practices.Methods:Data from the Belgian Epidemiological Psoriatic Arthritis Study (BEPAS), a prospective multicentre cohort involving 17 Belgian rheumatology practices. Recruitment was from December 2012 until July 2014. Patients were included in the study when the local rheumatologist could diagnose an existing or new PsA and when patients fulfilled the Classification criteria for Psoriatic Arthritis (CASPAR). Radiographs of the SIJ were obtained at baseline and after 2 years. Two calibrated readers assessed radiographic damage by grading the SIJ according to the modified New York (mNY) criteria. When assessing the images, readers were blinded for clinical data and information from other obtained images (radiographs of the hands, feet and spine). Individual scores as well as consensus scores are described.Results:In total 461 patients where included in BEPAS. Mean age was 52.79±12.29 years and 43.0% (n=198) were female; average disease duration was 8.5 ± 9.3 yrs and approximately 34% of the patients report inflammatory axial pain. From 338 patients SIJ radiographs were obtained. At baseline, the vast majority of patients did not fulfil the mNY criteria (n=325, 96.2%), according to both readers. In 8 cases (2.4%) there was concordance on fulfilment of the mNY criteria. Discordant cases (n=5, 1.4%) were equally distributed. Agreement between the 2 readers was good with 98.5% overall agreement and kappa=0.75. Therefore, with a more sensitive approach (any of the 2 readers scores mNY positive) we see slight differences; 13 patients (3.8%) fulfil the mNY criteria. Table 1 shows radiographic damage by individual readersTable.Baseline data on radiographic damage of the sacroiliac joints in Belgian patients with newly diagnosed or existing PsA included in the BEPAS.N=338Right sacroiliac jointLeft sacroiliac jointGradesType of lesionReader 1Reader 2Reader 1Reader 20No abnormalities298 (88.2%)301 (89.1%)298 (88.2%)296 (87.6%)1Indefinite abnormalities32 (9.5%)23 (6.8%)27 (8.0%)23 (6.8%)2-3Abnormalities5 (1.5%)12 (3.6%)9 (2.7%)19 (5.6%)Erosion3 (0.9%)11 (3.3%)4 (1.2%)18 (5.3%)Sclerosis4 (1.2%)12 (3.6%)5 (1.5%)13 (3.9%)Joint space alteration (narrowing or widening)1 (0.3%)1 (0.3%)4 (1.2%)2 (0.6%)Partial ankylosis2 (0.6%)3 (0.9%)5 (1.5%)8 (2.4%)4Total ankylosis3 (0.9%)2 (0.6%)4 (1.2%)-In 128 patients (37.9%) a follow-up x-ray after 2 years was available. In 124 patients (96.9%) there was reader agreement on mNY negative status. There was disagreement between readers on a positive mNY in 2 patients (equally distributed) and agreement on 2 patients (1.6%). There were no patients with consensus between readers on the change in mNY over 2 years, but 1 reader reported 1 patient becoming mNY positive after 2 years.Conclusion:Despite the patient self-identified presence of axial disease in up to 34% in this cohort of PsA patients, there was minimal radiographic damage on SIJ, suggesting that SIJ disease is not a major manifestation of PsA.Disclosure of Interests:Manouk de Hooge: None declared, Alla Ishchenko: None declared, Serge Steinfeld: None declared, Adrien Nzeusseu Toukap Grant/research support from: AbbVie, Celgene Corporation, Janssen, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Eli Lilly, Janssen, Novartis, UCB – consultant, Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, UCB – advisory board member, Dirk Elewaut: None declared, Hermine Leroi Employee of: MSD Belgium, Rik Lories Grant/research support from: AbbVie, Boehringer Ingelheim, Celgene Corporation, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Samumed and UCB – grant/research support (on behalf of Leuven Research and Development), Consultant of: AbbVie, Boehringer Ingelheim, Celgene Corporation, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Samumed and UCB – consultant (on behalf of Leuven Research and Development), Speakers bureau: AbbVie, Boehringer Ingelheim, Celgene Corporation, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Samumed and UCB – speaker (on behalf of Leuven Research and Development), Kurt de Vlam Grant/research support from: Celgene, Eli Lilly, Pfizer Inc, Consultant of: AbbVie, Eli Lilly, Galapagos, Johnson & Johnson, Novartis, Pfizer Inc, UCB, Filip van den Bosch Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB
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Augustine, Chinweuba Ukwueze, Chukwuka Ugwu Anthony, and Felix Erondu Okechukwu. "Academic achievement among radiography students in a Nigerian university: Does program interest count?" Journal of Public Health and Epidemiology 6, no. 3 (2014): 125–31. http://dx.doi.org/10.5897/jphe2013.0623.
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Maharjan, Surendra. "Radiation knowledge among radiographers and radiography students." Radiography Open 3, no. 1 (2017): 17. http://dx.doi.org/10.7577/radopen.2000.
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Objective To evaluate the knowledge of radiation among radiographers and radiography students in NepalMethods A validated questionnaire was conducted among radiographers and radiography students in 24th annual meeting and workshop of Nepal Radiological Society (NRS) on 10th September, 2015. The survey included multiple choice questions (MCQs) related to demographic characteristics (age, gender), academic qualification, work experience and knowledge of radiation. The data were analyzed using SPSS software version 21.0.Results Of total 102 respondents, 68.6% (70) were students and 31.4% (32) were radiographers. There were 65 male and 37 female with age ranging from 18 to 45, mean 23.70±5.11 years. Out of 14 MCQs related to knowledge of radiation, maximum score was 14 and minimum 5 with mean 9.99±1.94 (mean percentage 71.35%) (radiographers 10.63±2.10, 75.89% and students 9.70±1.80, 69.28%) respectively. Most participants failed in questions related to radiation units, minimum safe distance during portable radiography, fluoroscopy, and cancer risk of chest radiograph.Conclusion Overall awareness and knowledge of radiation was satisfying with definite possibilities for further improvement through regular trainings, workshops and continuing medical education (CME) programs related to radiation protection and safety. Furthermore, it is an urgent requirement of national radiation protection act in Nepal
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Ng, Curtise K. C., Peter White, and Janice C. McKay. "Establishing a method to support academic and professional competence throughout an undergraduate radiography programme." Radiography 14, no. 3 (2008): 255–64. http://dx.doi.org/10.1016/j.radi.2007.05.003.
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Rogero, Ryan, Justin Tsai, Rachel Shakked, and Steven Raikin. "Mid-term Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis with Bulk Femoral Head Allograft." Foot & Ankle Orthopaedics 3, no. 3 (2018): 2473011418S0040. http://dx.doi.org/10.1177/2473011418s00408.
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Category: Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis with bulk femoral head allograft has previously been reported as a way to fill large osseous hindfoot deficits in order to restore limb length, but few studies have been performed evaluating outcomes and prognostic factors. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors. Methods: A retrospective review of patients undergoing TTC arthrodesis with bulk femoral head allograft performed at an academic institution by a single fellowship-trained foot and ankle surgeon between 2004 and 2015 was conducted. Patient charts and operative reports were reviewed for patient and procedural variables, respectively. Radiographic union was assessed at the ankle and subtalar joints by another fellowship-trained foot and ankle surgeon not involved in any patient’s surgical care. Radiographic stability, defined as proper maintenance of hardware and graft positioning in the hindfoot, was also assessed. A procedure was “failed” if there was a need for revision surgery. Patients with a successful arthrodesis were contacted to score the Foot and Ankle Ability Measure-Active Daily Living (FAAM-ADL) questionnaire, visual analog scale (VAS) for pain, and Short Form-12 (SF-12) mental (MCS) and physical (PCS) components. 22 patients were identified, with average radiograph and functional follow-up times of 39.7 and 57.1 months, respectively. Results: Complete radiographic union of involved joints was achieved in 13 patients (59.1%) and in 72.7% (32/44) of all joints. Eighteen patients (81.8%) were assessed to be radiographically stable at final follow-up. Three patients (13.6%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 19 patients (86.4%) did not require additional surgery as of final follow-up. At an average of 57.1 months postoperatively, patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P<.001). The mean VAS for pain significantly improved from 76.8 to 32.9 (P<.001). The mean postoperative SF-12-MCS and SF- 12-PCS scores were 53.9 and 40.6. Additionally, 73.3% (11/15) reported being satisfied with their surgical outcomes. Male sex (P=.03) and a lateral operative approach (P=.03) both resulted in significantly worse outcomes. Conclusion: The utilization of a femoral head allograft with TTC arthrodesis in patients with large hindfoot defects is an acceptable method that can offer improved functional and sustained radiographic outcomes and patient satisfaction. Male sex and a lateral approach may be associated with an inferior prognosis.
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Dekker, Travis J., Kamran S. Hamid, Andrew E. Federer, et al. "The Value of Motion: Patient-Reported Outcome Measures Are Correlated With Range of Motion in Total Ankle Replacement." Foot & Ankle Specialist 11, no. 5 (2017): 451–56. http://dx.doi.org/10.1177/1938640017750258.
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Background: The proposed benefit of total ankle replacement (TAR) over ankle fusion is preserved ankle motion, thus we hypothesized that an increase in range of motion (ROM) is positively correlated with validated patient-reported outcome measures (PROMs) in individuals receiving TAR. Methods: Patients undergoing TAR at a single academic medical center between 2007 and 2013 were evaluated in this study. In addition to a minimum of 2-year follow-up, complete preoperative and postoperative outcome measures for the Foot and Ankle Disability Index (FADI), Short Musculoskeletal Function Assessment (SMFA) Bother and Function Indices, Visual Analog Scale (VAS), and 36-Item Short Form Health Survey (SF-36) were requisite for inclusion. Standardized weightbearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained and previously described ankle and foot measurements were performed to determine ankle ROM. Results: Eighty-eight patients met inclusion criteria (33 INBONE, 18 Salto-Talaris, 37 STAR). Mean time to final ROM radiographs was 43.8 months (range 24-89 months). All aforementioned PROMs improved between preoperative evaluation and most recent follow-up ( P < .01). Final ankle ROM was significantly correlated with postoperative FADI, SF-36 Mental Component Summary (MCS), SMFA Bother and Function Indices, and VAS. Additionally, dorsiflexion was positively associated with FADI, SF-36 MCS, and SMFA Function ( P < .05) but plantarflexion had no such influence on outcomes. No differences were identified with subset stratification by prosthesis type, fixed versus mobile-bearing design or etiology. Conclusion: In this TAR cohort with prospectively collected outcomes data, radiographic sagittal plane ankle motion was positively correlated with multiple PROMs. Disease-specific and generic health-related quality of life PROMs demonstrated improvement postoperatively in all domains when evaluating final total range of motion. Patients who undergo TAR for end-stage osteoarthritis with improvement in ROM demonstrate a direct correlation with improved patient-centric metrics and outcome scores. Levels of Evidence: Level III: Retrospective comparative study
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Hamid, Kamran, Travis Dekker, Mark Easley, James Nunley, and Samuel Adams. "The Value of Motion." Foot & Ankle Orthopaedics 2, no. 3 (2017): 2473011417S0000. http://dx.doi.org/10.1177/2473011417s000046.
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Category: Ankle, Ankle Arthritis Introduction/Purpose: The onus has been placed on surgeons to prove the value of procedures to patients, payers, policymakers and other key stakeholders. Demonstration of patient reported outcome measures (PROMs) constitutes an integral component of success within the context of value-based healthcare. The proposed benefit of total ankle replacement (TAR) over ankle fusion is preserved ankle motion, thus we hypothesized that an increase in range of motion (ROM) is positively correlated with validated PROMs in individuals receiving TAR. Methods: Patients undergoing TAR at a single academic medical center between 2007-2013 were evaluated in this study. In addition to a minimum of two-year follow-up, complete preoperative and postoperative outcome measures for the Foot and Ankle Disability Index (FADI), Short Musculoskeletal Function Assessment (SMFA) Bother and Function Indices, Visual Analog Scale (VAS) and 36-Item Short Form Health Survey (SF-36) were requisite for inclusion. Standardized weightbearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained and previously described ankle and foot measurements were performed to determine ankle ROM. Results: Eighty-eight patients met inclusion criteria (33 INBONE, 18 Salto-Talaris, 37 STAR). Mean time to final ROM radiographs was 43.8 months (range: 24-89 months). All aforementioned PROMs improved between preoperative evaluation and most recent follow-up (p<0.01). Final ankle ROM was significantly correlated with postoperative FADI, SF-36 Mental Component Summary (MCS), SMFA Bother and Function Indices, and VAS. Additionally, dorsiflexion was positively associated with FADI, SF-36 MCS and SMFA Function (p<0.05) but plantarflexion had no such influence on outcomes. No differences were identified with subset stratification by prosthesis type, fixed versus mobile-bearing design or etiology. Conclusion: In this TAR cohort with prospectively collected outcomes data, radiographic sagittal plane ankle motion was positively correlated with multiple PROMs. Disease-specific and generic health-related quality of life PROMs demonstrated improvement postoperatively in all domains. TAR is a viable option for patients with end-stage ankle arthritis and increased ROM is associated with improved patient-centric metrics.
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Tarazi, John M., Hytham S. Salem, Joseph O. Ehiorobo, et al. "Minimum 7-Year Outcomes of Dual Mobility Acetabular Cups in Total Hip Arthroplasty Patients." Journal of Hip Surgery 04, no. 02 (2020): 090–93. http://dx.doi.org/10.1055/s-0040-1713109.
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AbstractModular dual mobility cups have been developed to potentially address postoperative hip instability, which can occur in nearly 20% of all revision total hip arthroplasty (THA) patients. By having a prosthetic construct that contains two points of articulation between the femoral head and liner and between the liner and shell, joint stability can be increased. The purpose of this study was to report on dual mobility cup survivorships, patient satisfaction outcomes, complications, and radiographic outcomes at a minimum 7-year follow-up. A high-volume academic surgeon performed a total of 143 consecutive dual mobility primary THAs on patients who had a minimum follow-up of 7 years (range, 7–8.5 years). The study cohort consisted of 77 females (54%) and 66 males (46%) who had a mean age of 65 years (range, 34–90 years). Aseptic, septic, and all-cause survivorship was determined by Kaplan-Meier analysis. Harris Hip Scores (HHS), postoperative complications, and radiographs were also assessed. No cup failures were observed. Overall, septic survivorship was 99.3% (95% confidence interval [CI]: 0.98–1.0) and all-cause survivorship was 98.6% (95% CI: 0.97–1.0). Two patients (1.4%) required revision surgery unrelated to the use of a modular dual mobility cup. Of these, one patient experienced femoral stem loosening and the other developed a periprosthetic infection that was treated with a two-stage revision. The mean total HHS was above 95 points at the most recent follow-up. Three patients (2.3%) experienced medical complications, including two deep vein thromboses and one for nonfatal pulmonary embolism. Radiographic evidence revealed incomplete seating of the metallic liner in one patient. Dual mobility cups were developed in an attempt to decrease the rate of instability following THA. The results from this study indicate that excellent clinical and patient-reported outcomes can be achieved at 7-year follow-up in patients who undergo THA with a dual mobility cup. Therefore, dual mobility cups appear to be an appropriate treatment option for primary THA.
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Mandel, Jessica, Omar Behery, Rajkishen Narayanan, Sanjit R. Konda, and Kenneth A. Egol. "Single- vs 2-Screw Lag Fixation of the Medial Malleolus in Unstable Ankle Fractures." Foot & Ankle International 40, no. 7 (2019): 790–96. http://dx.doi.org/10.1177/1071100719840995.
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Background: The purpose of this study was to determine the efficacy of medial malleolar fixation with 1 vs 2 screws. Methods: Between April 2013 and February 2017, 196 patients who presented at 2 hospitals within one academic institution with an unstable rotational ankle fracture with a medial fracture and were treated operatively by a trained orthopedic surgeon were identified. These patients’ charts were reviewed and their injury, radiographic, surgical, and follow-up data recorded. Medial malleolus fragment size was assessed on the anteroposterior (AP) and lateral views of the initial injury radiograph. Functional outcome was assessed using Maryland Foot Score (MFS). Patients were grouped based upon the number of screws utilized to fox the medial malleolar fragment. Data were assessed using Fisher exact tests and independent t tests with SPSS, version 23. Results: Out of the 196 patients who met inclusion criteria, 47 patients (24%) were fixed with 1 medial malleolar screw and 149 patients (76%) were fixed with 2 screws. There were no differences among patients who received 1 vs 2 screws with regard to age, gender, body mass index, American Society of Anesthesiologists grade, or smoking status. The average malleolar fragment size was smaller in those treated with 1 screw on both the AP and lateral radiographic views than those with 2 screws ( P = .009, P = .001, respectively). There was no difference between groups in ankle dorsiflexion or plantarflexion at 1 year postoperation ( P = .451, P = .581). Patients who received 1 screw did not differ from those who received 2 screws with respect to Maryland Foot Scores ( P = .924). There was no difference in rate of revision surgery or need for hardware removal between groups ( P = .093). Furthermore, time to healing and postoperative complication rate did not differ between groups. Conclusion: The use of a single screw for medial malleolar fixation provided stable fixation to allow ankle fracture healing, without an increase in complications. This information is especially important in situations when the fragment is too small to accommodate multiple fixation points. Level of Evidence: Level III, retrospective case-control study.
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Higgins, Robert, Peter Hogg, and Leslie Robinson. "Research Informed Teaching Experience in Diagnostic Radiography: The Perspectives of Academic Tutors and Clinical Placement Educators." Journal of Medical Imaging and Radiation Sciences 48, no. 3 (2017): 226–32. http://dx.doi.org/10.1016/j.jmir.2017.06.002.
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Nyathi, T., M. L. Pule, P. Segone, D. G. Van der Merwe, and S. P. Rapoho. "A dose audit of fluoroscopy examinations at Charlotte Maxeke Johannesburg Academic Hospital: Analysis of preliminary results." South African Journal of Radiology 13, no. 2 (2009): 24. http://dx.doi.org/10.4102/sajr.v13i2.541.
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Purpose: To retrospectively analyze the radiation doses delivered to patients undergoing fluoroscopy examinations in terms of the skin dose and the dose-area product (DAP). Materials and Methods: The subjects of this study were patients who underwent fluoroscopy examinations at Charlotte Maxeke Johannesburg Academic Hospital, South Africa during the period August 2007 to March 2008. The skin dose and dose-area product values were obtained from a built-in DAP-meter installed on a digital Philips Medical Systems MultiDiagnost Eleva fluoroscopy unit. The following cases were analyzed namely barium swallow, barium meal, barium enema, hexabrix swallow, gastrografin meal, voiding cystourethrogram, fistulogram, myelogram, nephrostomy and loopogram. Results: An analysis of three hundred and thirty one examinations is presented. From the recorded data the following quantities were deduced: the mean- and range of the skin doses and DAPs, mean screening time and mean fluoroscopy duration. An analysis of the screening time for the various examinations showed a weak correlation (r = 0.59) between skin dose and screening time, while a poor correlation (r = 0.42) was deduced between DAP reading and screening time. Conclusion: There is a wide spread in the radiation doses registered for any one given type of examination. The large variability in the radiation dose delivered proves that fluoroscopic examinations stand to gain from dose optimization. The usefulness and potential use of DAP meters with regards to dose optimization in radiology is shown. In line with efforts to optimize dose from diagnostic radiography examinations the authors recommend the establishment of diagnostic reference levels (DRLs) in South Africa for the most frequent examinations in general radiography, fluoroscopy, mammography and computed tomography. Keywords: patient dose, genetic risk, dose optimization, dose reference levels
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Scheepers, Shaun, and Savvas Andronikou. "Beware the bifid rib!" South African Journal of Radiology 14, no. 4 (2010): 104. http://dx.doi.org/10.4102/sajr.v14i4.454.
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A 4-year-old girl was referred to Tygerberg Academic Hospital with a long-standing history of an asymptomatic anterior chest wall ‘lump’. On physical examination, a bony mass was palpated in relation to the anterior aspect of the left 4th rib. Plain radiography demonstrated anterior widening of the left 4th rib. Fearing a sinister cause, a multidetector computed tomography (MDCT) examination of the chest, with 3D reconstruction and volume rendering, was performed. A congenital bifid left 4th rib was demonstrated.
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Gross, Christopher, Ariel Palanca, and Russell Chapin. "MRI Utilization by Orthopaedic and Non-orthopaedic providers for acute or chronic ankle pain." Foot & Ankle Orthopaedics 2, no. 3 (2017): 2473011417S0001. http://dx.doi.org/10.1177/2473011417s000186.
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Category: Ankle Introduction/Purpose: The use of MRI poses a significant expense in the ever-increasing cost of healthcare. The American College of Radiology (ACR) recommends obtaining ankle radiographs within 6 months prior to MRI in the assessment of patients with acute or chronic ankle pain. In this retrospective utilization study, we examine the compliance rate of both orthopedic and non-orthopedic providers at two academic centers. We hypothesize that there is an over utilization of resources by non- orthopaedic surgeons. Methods: We retrospectively reviewed 721 patient charts (4/2015-11/2016) who had an ankle MRI. We analyzed the preceding conservative management and subsequent non-operative or surgical care of the patient, and made note of the ordering physician and whether or not radiographs were obtained prior to ordering an MRI. We also performed an analysis of diagnosis and identified common diagnoses that were associated higher levels of non-compliance to the ACR criteria. Results: Overall, we determined that 222 of the 259 (85.7%) of the orthopedic providers obtained radiographs prior to MRI while only 271of 462 (58.7%) non-orthopedic providers followed these criteria (p<0.0001). In total, we found that 493 out of 721 (68.4%) providers ordered ankle radiographs prior to MRI. Among orthopedic providers showing non-compliance with the ACR criteria, the most common patient diagnoses were tendinopathy and not obtaining new radiographs when radiographs were older than 6 months. Among non-orthopedic providers, the most common diagnoses were edema and tendinopathy. Conclusion: We found that orthopedic providers adhered much more closely to the ACR criteria, and that there is a significant over-utilization of resources by all providers, with an overall inappropriate use percentage of 32.1%. Increasing the compliance rate could prove to be an effective mechanism for decreasing the cost healthcare in the treatment of ankle pain.
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Velasco, Brian, Michael Ye, Bonnie Chien, John Y. Kwon, and Christopher P. Miller. "Incidental Findings on Foot and Ankle Radiographs as Compared to Other Anatomic Regions." Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0007. http://dx.doi.org/10.1177/2473011419s00076.
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Category: Orthopedic Radiology Introduction/Purpose: Radiographs are one of the most common and widely available diagnostic imaging techniques that are used to evaluate orthopedic conditions. However, incidental findings on imaging may be observed as well, some of which may be very serious and have significant heath as well as legal ramifications if missed. This study evaluates the number of clinically relevant incidental findings reported for orthopaedic radiographs ordered in an academic orthopedic multispecialty group over one year. Methods: A retrospective review was conducted of 13,948 eligible radiographs recorded at our institution over a 12-month period. Reports were categorized based on exam type. Incidental findings were first categorized as either concern for malignancy or non-malignancy. The possibly malignant findings were further subdivided into malignancies in Bone or Lung tissues. The non- malignant findings were categorized into the following groups: Benign Bone Disease, Gastrointestinal Pathology, Gynecologic Pathology, Incidental Fracture, Infection, Inflammation, Respiratory Pathology, Soft Tissue Mass, Urologic Pathology, Vascular Pathology or Other. Results: Of the 13,948 radiographs, 286 radiographs reported at least one incidental finding totaling to 287 (2.06%) incidental findings. The 3 studies with the highest rates of incidental findings were Leg Length Alignment films (3.94%), Spine (3.88%), and Pelvis & Hip (2.76%). The three categories with the lowest rates of incidental findings were Hand & Wrist (0.56%), Tibia/Fibula Foot & Ankle (0.84%), and Forearm & Elbow (1.13%). Over one-third of incidental findings concerned malignancy or metastases with 87 (30.1%) and 18 (6.23%) identified in bone tissue and lung tissue, respectively. Benign Bone Disease (24.9%), Gastrointestinal Pathology (6.57%), and Gynecologic Pathology (5.88%) were categories with the highest rates of non-malignant incidental findings. Follow-up was recommended for 122 (42.5%) incidental findings. Conclusion: This study describes the rates of incidental findings on orthopedic radiographs. Radiographs of midline structures are more likely to report an incidental finding as opposed to radiographs of distal extremities. The exception is leg alignment films because these image the entirety of the lower extremity and the pelvis and thus a far larger volume of the body. Over one-third of incidental findings concerned possible malignancy or metastases and therefore follow-up with focused imaging should be recommended if suspicious. This information will be particularly useful for orthopaedic surgeons who read their own radiographs without a radiologist formally reviewing the films.
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Dhoot, Roshni, John M. Humphrey, Patrick O'Meara, et al. "Implementing a mobile diagnostic unit to increase access to imaging and laboratory services in western Kenya." BMJ Global Health 3, no. 5 (2018): e000947. http://dx.doi.org/10.1136/bmjgh-2018-000947.
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Access to basic imaging and laboratory services remains a major challenge in rural, resource-limited settings in sub-Saharan Africa. In 2016, the Academic Model Providing Access to Healthcare programme in western Kenya implemented a mobile diagnostic unit (MDU) outfitted with a generator-powered X-ray machine and basic laboratory tests to address the lack of these services at rural, low-resource, public health facilities. The objective of this paper is to describe the design, implementation, preliminary impact and operational challenges of the MDU in western Kenya. Since implementing the MDU at seven rural health facilities serving a catchment of over half a million people, over 4500 chest radiographs have been performed, with one or more abnormalities detected in approximately 30% of radiographs. We observed favorable feedback and uptake of MDU services by healthcare workers and patients. However, various operational challenges in the design and construction of the MDU and the transmission and reporting of radiographs in remote areas were encountered. Our experience supports the feasibility of deploying an MDU to increase access to basic radiology and laboratory services in rural, resource-limited settings.
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Kawooya, Michael G. "Training for Rural Radiology and Imaging in Sub-Saharan Africa: Addressing the Mismatch Between Services and Population." Journal of Clinical Imaging Science 2 (June 29, 2012): 37. http://dx.doi.org/10.4103/2156-7514.97747.
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The objectives of this review are to outline the needs, challenges, and training interventions for rural radiology (RR) training in Sub-Saharan Africa (SSA). Rural radiology may be defined as imaging requirements of the rural communities. In SSA, over 80% of the population is rural. The literature was reviewed to determine the need for imaging in rural Africa, the challenges, and training interventions. Up to 50% of the patients in the rural health facilities in Uganda may require imaging, largely ultrasound and plain radiography. In Uganda, imaging is performed, on an average, in 50% of the deserving patients in the urban areas, compared to 10–13 % in the rural areas. Imaging has been shown to increase the utilization of facility-based rural health services and to impact management decisions. The challenges in the rural areas are different from those in the urban areas. These are related to disease spectrum, human resource, and socio-economic, socio-cultural, infrastructural, and academic disparities. Countries in Sub-Saharan Africa, for which information on training intervention was available, included: Uganda, Kenya, Tanzania, Rwanda, Zambia, Ghana, Malawi, and Sudan. Favorable national policies had been instrumental in implementing these interventions. The interventions had been made by public, private-for-profit (PFP), private-not-for profit (PNFP), local, and international academic institutions, personal initiatives, and professional societies. Ultrasound and plain radiography were the main focus. Despite these efforts, there were still gross disparities in the RR services for SSA. In conclusion, there have been training interventions targeted toward RR in Africa. However, gross disparities in RR provision persist, requiring an effective policy, plus a more organized, focused, and sustainable approach, by the stakeholders.
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Elsamadicy, Aladine A., David T. Lubkin, Amanda R. Sergesketter, et al. "Rate of instrumentation changes on postoperative and follow-up radiographs after primary complex spinal fusion (five or more levels) for adult deformity correction." Journal of Neurosurgery: Spine 30, no. 3 (2019): 376–81. http://dx.doi.org/10.3171/2018.9.spine18686.
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OBJECTIVEIn the United States, healthcare expenditures have been soaring at a concerning rate. There has been an excessive use of postoperative radiographs after spine surgery and this has been a target for hospitals to reduce unnecessary costs. However, there are only limited data identifying the rate of instrumentation changes on radiographs after complex spine surgery involving ≥ 5-level fusions.METHODSThe medical records of 136 adult (≥ 18 years old) patients with spine deformity undergoing elective, primary complex spinal fusion (≥ 5 levels) for deformity correction at a major academic institution between 2010 and 2015 were reviewed. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient. The authors reviewed the first 5 subsequent postoperative and follow-up radiographs, and determined whether revision of surgery was performed within 5 years postoperatively. The primary outcome investigated in this study was the rate of hardware changes on follow-up radiographs.RESULTSThe majority of patients were female, with a mean age of 53.8 ± 20.0 years and a body mass index of 27.3 ± 6.2 kg/m2 (parametric data are expressed as the mean ± SD). The median number of fusion levels was 9 (interquartile range 7–13), with a mean length of surgery of 327.8 ± 124.7 minutes and an estimated blood loss of 1312.1 ± 1269.2 ml. The mean length of hospital stay was 6.6 ± 3.9 days, with a 30-day readmission rate of 14.0%. Postoperative and follow-up change in stability on radiographs (days from operation) included: image 1 (4.6 ± 9.3 days) 0.0%; image 2 (51.7 ± 49.9 days) 3.0%; image 3 (142.1 ± 179.8 days) 5.6%; image 4 (277.3 ± 272.5 days) 11.3%; and image 5 (463.1 ± 525.9 days) 15.7%. The 3rd year after surgery had the highest rate of hardware revision (5.55%), followed by the 2nd year (4.68%), and the 1st year (4.54%).CONCLUSIONSThis study suggests that the rate of instrumentation changes on radiographs increases over time, with no changes occurring at the first postoperative image. In an era of cost-conscious healthcare, fewer orders for early radiographs after complex spinal fusions (≥ 5 levels) may not impact patient care and can reduce the overall use of healthcare resources.
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Domina, Jason G., Ramon Sanchez, Indu R. Meesa, and Emmanuel Christodoulou. "Evaluation of pediatric VCUG at an academic children’s hospital: is the radiographic scout image necessary?" Pediatric Radiology 45, no. 6 (2014): 855–61. http://dx.doi.org/10.1007/s00247-014-3241-4.
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Kridiotis, Carol Anne, Johan Bezuidenhout, and Jacques Raubenheimer. "Selection criteria for a radiography programme in South Africa: Predictors for academic success in the first year of study." Health SA Gesondheid 21 (December 2016): 206–13. http://dx.doi.org/10.1016/j.hsag.2016.01.005.
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Fields, Michael W., Neil K. Kaushal, Neeraj M. Patel, et al. "VARIABILITY IN EVALUATION AND TREATMENT OF PEDIATRIC TIBIAL TUBERCLE FRACTURES AMONGST PEDIATRIC ORTHOPAEDIC SURGEONS." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (2021): 2325967121S0005. http://dx.doi.org/10.1177/2325967121s00056.
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Introduction: Tibial tubercle fractures are uncommon injuries typically seen in adolescents approaching skeletal maturity. No evidence based clinical practice guidelines currently exist regarding clinical management of both operative and nonoperative fractures. Purpose: To determine the variability in clinical management of tibial tubercle fractures among a group of pediatric orthopaedic surgeons. Methods: Nine fellowship trained academic pediatric orthopaedic surgeons reviewed 51 anteroposterior and lateral knee radiographs with associated case age (mean: 13.6yrs, range: 9-16yrs) and gender (86%male). Respondents were asked to describe each fracture using the Ogden classification (Type 1-5 with A/B modifiers), desired radiographic workup, operative vs. nonoperative treatment strategy, and plans for post treatment follow-up. Interrater reliability was determined among the surgeons using Fleiss Kappa analysis. Results: Fair agreement was reached when classifying the fracture type using the Ogden classification (k=0.39,p<0.001). There was slight agreement when determining if CT (k=0.10,p<0.001) should be ordered and when rating concern for compartment syndrome (k=0.17,p<0.001). Overall, surgeons had moderate agreement on whether to treat the fractures operatively vs. nonoperatively (k=0.51,p<0.001). Nonoperative management was selected for 80.4%(45/56) of Type 1A fractures. Respondents selected operative treatment for 75% (30/40) of Type 1B, 58.3% (14/24) of Type 2A, 97.4%(74/76) of Type 2B, 90.7%(39/43) of Type 3A, 96.3%(79/82) of Type 3B, 71.9%(87/121) of Type 4, and 94.1%(16/17) of Type 5 fractures. Regarding operative treatment, moderate agreement was reached when evaluating the emergent nature of the fracture (k=0.44,p<0.001) and surgical technique (k=0.44, p<0.001). However, only fair/slight agreement was reached when selecting the specifics of operative treatment including surgical fixation technique (k=0.25,p<0.001), screw type (k=0.26, p<0.001), screw size (k=0.08,p<0.001), use of washers (k=0.21,p<0.001), and performing a prophylactic anterior compartment fasciotomy (k=0.20,p<0.001). There was moderate agreement on radiographic work up at first (k=0.5,p<0.0011) and final (k=0.49,p<0.001) follow up visits. Surgeons had moderate agreement on plans to remove hardware (k=0.39,p<0.001). Non-operative treatment of fractures was observed to have only fair agreement (k=0.29,p<0.001). Furthermore, surgeons had fair/moderate agreement regarding the specifics of nonoperative treatment including degree of knee extension during immobilization (k=0.46,p<0.001), length of immobilization (k=0.34,p<0.001), post treatment weight bearing status (k=0.30,p<0.001), and post treatment rehabilitation (k=0.34,p<0.001). Finally, there was moderate agreement on radiographic work up at first (k=0.51,p<0.001) and final follow up (k=0.46,p<0.001). Conclusion: Significant variability exists between surgeons when evaluating and treating pediatric tibial tubercle fractures. Future studies should aim to create best practice guidelines for pediatric orthopaedic surgeons to reference when treating these fractures. [Table: see text]
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Lewis, Jennifer A., Heidi Chen, Kathryn E. Weaver, et al. "Low Provider Knowledge Is Associated With Less Evidence-Based Lung Cancer Screening." Journal of the National Comprehensive Cancer Network 17, no. 4 (2019): 339–46. http://dx.doi.org/10.6004/jnccn.2018.7101.
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Background: Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT. Patients and Methods: A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge. Results: Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24–0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4–5.0) within the past year. Conclusions: Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.
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Chianese, J., and B. Channon. "Teaching, learning and assessment of undergraduate radiography students: a strategy to develop progression towards competency." Journal of Radiotherapy in Practice 3, no. 1 (2002): 3–11. http://dx.doi.org/10.1017/s1460396902000110.
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A new clinical teaching, learning and assessment strategy for radiotherapy and diagnostic imaging undergraduates was developed by action research. Outcome-based competencies were used together with other strategies to progress students' learning through successive levels with the aim of developing essential and desirable attributes of the respective professions. The planning team consisted of academic and clinical staff resulting in a shared project. Specific outcomes for each profession were devised by subgroups of the original team. The radiotherapy scheme implemented formative staged outcomes and the report focuses mainly on this strategy. Evaluation reveals that discriminations can be made at an early stage between those students achieving and those who are not. Highlighting specific areas for improvement allows opportunities for remedial work and creation of individual action plans. Key clinical staff underwent specific training to facilitate students' development and act as effective gatekeepers to progression. Recommendations for further research are to survey graduates now in employment to investigate how well they feel the scheme has fitted them for practice. There is also the potential to survey those who left the course prior to completion to discover if the scheme has helped to develop transferable skills for life long learning.
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Trebbia, P., and G. Ferrar. "Quantitation of X-Ray Radiographic Elemental Maps Using Factorial Analysis of Correspondence: Methods and Programs." Microscopy and Microanalysis 2, no. 1 (1996): 21–34. http://dx.doi.org/10.1017/s1431927696210219.
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We examine the problem of building quantitative elemental maps from X-ray absorption images (radiography). As we suggested in a previous publication in Microbeam Analysis, factorial analysis of correspondence is shown to be an optimal method, in the least squares sense, for solving the multilinear equation system given by Beer's law: it relates to an efficient description of the problem in the concentration phase space. We explain how factorial analysis is related to singular value decomposition and we give a complete description of the algorithm. The method can be applied to any multilinear analytical technique as well. Programs are written in C and Mathematica® languages. Academic users may obtain the relevant software (source and code) as freeware directly from the authors.