Standardised or individualised X-ray tube angle for mediolateral oblique projection in digital mammography?

IntroductionWe aimed to investigate whether there were any differences in positioning criteria related to the presentation of the pectoralis major muscle (pectoral muscle) for women of different heights using a standardized 60° X-ray tube angle for mammograms in mediolateral oblique (MLO) projection.MethodsData from MLO mammograms of right breasts of 45,193 women screened in BreastScreen Norway 2016–2019 were used. The positioning criteria were related to the pectoral muscle length (measure A and measure B), width and shape and considered adequate or inadequate depending on the degree of fulfilling the criteria. Data associated with the pectoral muscle were extracted from Volpara, an automated software for breast density assessment. Information on height was obtained from a self-reported questionnaire received by the women together with the invitation to attend the screening program. Women were divided into three groups based on the height percentiles (P) in the Norwegian growth curves: < 25th percentile (<P25th: ≤163 cm), 25th-75th percentile (P25–P75th: 164–170 cm), and >75th percentile (>P75th: >170 cm). Logistic regression was used to analyse the odds of adequate pectoral muscle length A and B, and shape, adjusting each model for screening technique and equipment model. Results were presented with odds ratios (OR) and 95% confidence intervals (CI).ResultsMean age of the screened women was 61.5 (SD = 4.8) years. The adequate measure for the pectoral muscle length A was obtained for 25.9% (11,724/45,193), length B for 76.3% (34,489/45,193), width for 75.0% (33,894/45,193) and shape for 97.6% (44,118/45,193) of the mammograms. Adjusted odds of an adequate pectoral muscle length A were lower for women of <P25th (OR = 0.90, 95% CI: 0.86–0.95) compared to women of P25-75th. Odds of an adequate pectoral muscle length B were lower for women of <P25th (OR = 0.88, 95% CI 0.84–0.93) and higher for women of >P75th (OR = 1.08, 95% CI 1.02–1.14) compared to women of P25-75. Odds of an adequate pectoral muscle shape were higher for women of <P25th (OR = 1.14, 95%CI 1.08–1.19) and lower for women of >P75th (OR = 0.92, 95% CI 0.87–0.97) compared to women of P25-75th.ConclusionThe 60° X-ray tube angle might suit most of the female population offered mammographic screening in Norway, but women of a relatively low height (163 cm or lower) might benefit from an X-ray tube angle less than 60-degrees.Implications for practiceUsing 60° X-ray tube angle for the MLO mammograms in BreastScreen Norway fit the majority of the participating women. More research is needed to change the protocol associated with the tube angle for women shorter than 163 cm.     

Lunate dislocation causing median nerve entrapment

Lunate dislocation is an uncommon injury occurring in young adults due to high-energy trauma. The volar displacement of the bone may result in compression of the median nerve within the carpal tunnel and is an uncommon cause of entrapment neuropathy.     

Alkaptonuric ochronosis: a case with multiple joint replacement arthroplasties

Alkaptonuria is an extremely rare hereditary disorder of metabolism which may affect various systems. Degeneration of the articular surfaces in major joints leads to complications, which may further necessitate joint replacements. In this report, a case of advanced alkaptonuria with multiple joint replacements is presented and musculoskeletal system involvement in this disorder is reviewed.Abbreviations HGA Homogentisic acid     

Lenke 1型青少年特发性脊柱侧弯脊柱-骨盆矢状位与冠状位参数的相关性

目的：探索Lenke 1型青少年特发性脊柱侧弯（ adolescent idiopathic scoliosis, AIS）患者的脊柱-骨盆矢状位参数与冠状位参数的相关性。方法：回顾2005年4月至2013年11月北京大学第三医院诊治的Lenke 1型AIS患者,在正、侧位片上测量和记录顶锥（apical vertebra, AV）位置、主胸弯Cobb角（main thoracic, MT）,以及骨盆入射角（pelvic incidence, PI）、C7转移比值（C7 translation ratio, C7TR）等矢状位参数,运用统计软件进行参数间的比较和相关性分析。结果：共收集病例51例,其中男18例,女33例,平均年龄（14．9±2．0）岁,顶锥位置在T7～T11, MT为（49．6°±16．7°）,PI值为（44．7°±6．7°）。 PI与PT、SS和LL,LL与SS和TK等有相关性（P均＜0．05）。不同腰椎修饰（ lumbar modifiers, LM）组的TK、LL、PT差异具有统计学意义,其他矢状位参数差异无统计学意义。 AV位置与脊柱-骨盆矢状位各参数相关性不显著, MT与TK、LL、SS显著相关,与PI相关性不显著。结论：Lenke 1型AIS的多数脊柱-骨盆矢状位参数间显著相关,形成以PI为核心的矢状位平衡调节链,部分冠、矢状位参数间有显著相关性。     

The evaluation of the sensitivity and specificity of wrist examination findings for predicting fractures

Background

The aim of this study was to evaluate the sensitivity and specificity of physical examination findings and functional tests in adult acute wrist trauma patients who presented to the emergency department (ED) and to create a reliable and practical clinical decision rule for determining the necessity of radiography in wrist trauma.

Criteria to Screen for Traumatic Cervical Spine Instability: A Consensus of Chiropractic Radiologists

Objective

The purpose of this study was to establish consensus on a radiographic definition for cervical instability for routine use in chiropractic patients who sustain trauma to the cervical spine.

UK reporting radiographers’ perceptions of AI in radiographic image interpretation – Current perspectives and future developments

IntroductionRadiographer reporting is accepted practice in the UK. With a national shortage of radiographers and radiologists, artificial intelligence (AI) support in reporting may help minimise the backlog of unreported images. Modern AI is not well understood by human end-users. This may have ethical implications and impact human trust in these systems, due to over- and under-reliance. This study investigates the perceptions of reporting radiographers about AI, gathers information to explain how they may interact with AI in future and identifies features perceived as necessary for appropriate trust in these systems.MethodsA Qualtrics® survey was designed and piloted by a team of UK AI expert radiographers. This paper reports the third part of the survey, open to reporting radiographers only.Results86 responses were received. Respondents were confident in how an AI reached its decision (n = 53, 62%). Less than a third of respondents would be confident communicating the AI decision to stakeholders. Affirmation from AI would improve confidence (n = 49, 57%) and disagreement would make respondents seek a second opinion (n = 60, 70%). There is a moderate trust level in AI for image interpretation. System performance data and AI visual explanations would increase trust.ConclusionsResponses indicate that AI will have a strong impact on reporting radiographers’ decision making in the future. Respondents are confident in how an AI makes decisions but less confident explaining this to others. Trust levels could be improved with explainable AI solutions.Implications for practiceThis survey clarifies UK reporting radiographers’ perceptions of AI, used for image interpretation, highlighting key issues with AI integration.     

Changing the model of radiography practice: Challenges of role advancement and future needs for radiographers working in the UAE

IntroductionThe radiographers' role in the United Arab Emirates (UAE) is focused on image acquisition with a willingness to accept advanced practice roles after appropriate education and training. Radiographers working in the UAE are highly motivated and ambitious to achieve those internationally identified levels of professional recognition and opportunities for role advancement. This study investigates the radiographers’ perspectives, perceptions and hopes for role advancement in the UAE.MethodsA qualitative research study design using Focus Group Discussions (FGD) was used to elicit the perceptions of radiographers. Participants were radiographers working in the hospitals and clinics supervised by the Ministry of Health and Prevention. Participants were asked about the recognized tasks defined as advancement roles, needs for roles clinically, challenges and requirements to prepare radiographers to participate in extended/developed roles. The discussions were audio recorded and later transcribed by an independent research assistant. Thematic analysis was used for data analysisResults29 radiographers participated in the FGDs, and 83% (n = 24) were interested in role advancement. FGD revealed that their current practice showed some informal extended role that may promote career progression. The most significant challenges identified by participants was their knowledge level as provided by the current curriculum and the need for education and licensing body support to accommodate change.ConclusionThe study identified a need for education and licensing body support to enable change in roles by radiographers, through improving radiographer knowledge and experience for role advancement.Implications for practiceTo sustain role advancement, formal intense training and education are necessary, normally above bachelor's degree level. Furthermore, establishing standards, licensing organizations/professional bodies should be part of the transformation of the profession to enable internationally recognized models to be followed.