European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.     

从环境隐喻的角度看外感病的因机证治＊

外感病是感受六淫、疫毒等外界因素引起的疾病，现代医学认为其主要致病因素为细菌或病毒。在以肉身体验为主要认知手段的古代，中医学家不可能发现细菌或病毒的存在，因而中医学家往往以天人相应的整体观来把握认知外感病。由于外感病的发病与传播受到外界气候环境和社会环境的影响，尤与人体的内环境密切相关。有鉴于此，本文从“环境隐喻”的立场出发，对外感病发病的因机证治进行分析。外界的气候环境和社会环境容易被人们感受，而对于古代无法观察人体的内环境，作者借助《论语·季氏将伐颛臾》中“祸起萧墙”的故事，对人体内环境为何与外感病的发病关系密切作以阐释，并通过人参败毒散、达原饮等方证的案例式说明，揭示清理人体内外环境而达治疗外感病的机理。     

Can the measured angle ABC on the lateral projection of the knee be used to determine the tube angulation for an optimum skyline projection?

IntroductionThe current technique of angulating for a skyline knee projection relies heavily on the radiographer's estimation of the patella tilt, rendering it subjective and prone to errors. This study therefore aims to (i) examine the correlation between angle ABC measured on the lateral X-ray image and skyline angulation (measured in degrees) and (ii) determine the inter-rater reliability of angle ABC measurements.Methods145 sets of lateral and skyline X-ray images from patients aged 40–70 years old were retrospectively analysed. Angle ABC was measured using prominent landmarks such as the trochlear sulcus, tibial tuberosity and the anterior border of the patella on the lateral knee radiograph. It was then retrospectively compared with the skyline tube angulations to identify any correlation between the two. An inter-rater reliability test was also conducted using the intraclass correlation coefficient (ICC) to determine the reproducibility of the measurement method.ResultsA weak correlation was found between angle ABC and skyline angulation (r = 0.1, p = 0.25). The proposed method of measurement shows good inter-rater reliability (ICC = 0.81, 95% CI: 0.77 to 0.84).ConclusionThere is insufficient evidence to indicate a correlation between angle ABC and skyline angulation. However, angle ABC can be reliably measured, implying the replicability of the measurement method for other purposes.Implications for practiceThe proposed measurement method of angle ABC on the lateral view could have future applications in other areas such as in the measurement of patellofemoral alignment and trochlear morphology.     

Evaluation of hindfoot and knee alignment by the hip-to-calcaneus view in patients with knee osteoarthritis and healthy individuals

BackgroundHip-to-calcaneus (HC) view is a whole-leg standing view that can visualize the hindfoot in detail. The aim of this study was to investigate the reliability and validity of tibiocalcaneal angle in HC view (H-TCA) by comparing it with that in long axial view (L-TCA). We also verified whether periarticular knee alignment parameters, measured conventionally in whole-leg standing radiography, could be measured in HC view.MethodSixty healthy volunteers and 61 patients with medial knee osteoarthritis were included. H-TCA was measured by two examiners in the healthy group, and intra-class correlation coefficients (ICCs) were evaluated. H-TCA and L-TCA were then measured in the healthy and osteoarthritis groups and correlated. Finally, we measured hip–knee–ankle angle, mechanical axis deviation ratio, mechanical lateral distal femoral angle, medial proximal tibial angle, and joint-line convergence angle in HC view and conventional whole-leg standing radiography to evaluate statistical differences and correlations.ResultsThe intra-observer and inter-observer ICCs were 0.86 and 0.76, respectively. Correlation coefficients (r) between H-TCA and L-TCA were r = 0.87 in healthy group and r = 0.81 in osteoarthritis group, indicating a strong positive correlation in both groups. There was no significant difference in periarticular knee alignment parameters between HC view and conventional whole-leg radiography.ConclusionsHindfoot evaluation in HC view showed high intra-observer and inter-observer reliabilities and strong positive correlation with TCA in long axial view. By using HC view before knee surgery, such as total knee arthroplasty, other necessary alignments can be evaluated simultaneously.     

Parts‐based representations of perceived face movements in the superior temporal sulcus

Facial motion is a primary source of social information about other humans. Prior fMRI studies have identified regions of the superior temporal sulcus (STS) that respond specifically to perceived face movements (termed fSTS), but little is known about the nature of motion representations in these regions. Here we use fMRI and multivoxel pattern analysis to characterize the representational content of the fSTS. Participants viewed a set of specific eye and mouth movements, as well as combined eye and mouth movements. Our results demonstrate that fSTS response patterns contain information about face movements, including subtle distinctions between types of eye and mouth movements. These representations generalize across the actor performing the movement, and across small differences in visual position. Critically, patterns of response to combined movements could be well predicted by linear combinations of responses to individual eye and mouth movements, pointing to a parts‐based representation of complex face movements. These results indicate that the fSTS plays an intermediate role in the process of inferring social content from visually perceived face movements, containing a representation that is sufficiently abstract to generalize across low‐level visual details, but still tied to the kinematics of face part movements.     

《黄帝内经》影响下的《金匮要略》“气化观”探析

探究《黄帝内经》影响下的《金匮要略》"气化观"。运用历史考察、文本分析等文献研究方法，对先秦两汉文化背景下，《黄帝内经》等著作中"气化"这一概念所体现的哲学、医学内涵进行分析，从道、法、术3个层面揭示在其影响下的《金匮要略》"气化观"的形成原因。秦汉哲学认为"气化"是宇宙万物生成的原因和运动的法则，古代医学认为人体气化遵循天地四时阴阳、五行的运行方式，这些都影响了《金匮要略》健康观、诊疗观及其遣方用药原则的形成。《黄帝内经》对《金匮要略》气化理论的构建产生重要影响。     

Utility of the 3‐Vessel and 3‐Vessel and Trachea Views in Prenatal Diagnosis of a Pulmonary Artery Sling

A pulmonary artery (PA) sling is a very rare congenital cardiovascular anomaly, and only a few studies have reported PA slings in fetuses. The relationship of the PA, aorta, ductus arteriosus, and trachea can be evaluated in the 3‐vessel and 3‐vessel and trachea views during fetal echocardiography. A PA sling can be detected by abnormal positioning of the left PA in relation to the trachea when sweeping from the 3‐vessel view cranially to the 3‐vessel and trachea view. Here we report 3 cases of fetal PA slings and their follow‐ups. Two cases were confirmed by postnatal echocardiography, and the other case was confirmed by a cardiovascular cast after pregnancy termination. We emphasize that the 3‐vessel and 3‐vessel and trachea views are of crucial importance in the prenatal diagnosis of a PA sling.