Correlation between occult bone lesions and meniscoligamentous injuries in patients with traumatic knee joint disease

To identify any correlation between the distribution of occult bone lesions and meniscoligamentous injuries, magnetic resonance images of 333 patients with traumatic knee joint disease were reviewed. Bone lesions of the knee were commonly associated with medial meniscal injuries and/or anterior cruciate ligament injuries. While knees with bone lesions showed a higher incidence (P < 0.05) of anterior cruciate ligament injury than knees without bone lesions, the presence of a lateral femoral condylar lesion resulted in a significantly higher incidence of anterior cruciate ligament injuries (P < 0.01). However, no significant positive correlation was found between other occult bone lesions and meniscoligamentous injuries.     

Visualization and quantitative analysis of talocrural joint kinematics

The three dimensional (3D) in vivo kinematic behavior of the ankle joint was evaluated using spiral volumetric CT scanning of a normal adult foot. The CT data were reconstructed and interpolated to create an isotropic 3D data volume. These data were rendered, visualized, segmented into their bony elements, labeled, and exported to disk using Mayo Analyze^™ software. The labeled 3D CT datasets were analyzed to determine relative orientation, translation, and rotation of the tibia-talus, tibia-calcaneus and calcaneus-talus. Using these results, the 3D motion characteristics during normal adult foot flexion/extension were described quantitatively.     

CT and MR findings in synovial chondromatosis of the temporo-mandibular joint: Our experience and review of literature

Objective

To compare Computed Tomography (CT) and Magnetic Resonance (MR) features and their diagnostic potential in the assessment of Synovial Chondromatosis (SC) of the Temporo-Mandibular Joint (TMJ).

Materials and methods

Eight patients with symptoms and signs compatible with dysfunctional disorders of the TMJ underwent CT and MR scan. We considered the following parameters: soft tissue involvement (disk included), osteostructural alterations of the joints, loose bodies and intra-articular fluid. These parameters were evaluated separately by two radiologists with a “double blinded method” and then, after agreement, definitive assessment of the parameters was given. CT and MR findings were compared.

Results

Histopathological results showed metaplastic synovia in all patients and therefore confirmed diagnosis of SC. MR resulted better than CT in the evaluation of all parameters except the osteostructural alterations of the joints, estimated with more accuracy by CT scan.

Conclusions

CT scan is excellent to define bony surfaces of the articular joints and flogistic tissue but it fails in the detection of loose bodies when these are not yet calcified. MR scan therefore is the gold standard when SC is suspected since it can visualize loose bodies at early stage and also evaluate disk condition and eventual extra-articular tissues involvement. The use of T2-weighted images and contrast medium allows identifying intra-articular fluid, estimating its entity and discriminating from sinovial tissue.     

Automatic detection of calcifications in the aorta from CT scans of the abdomen. 3D computer-aided diagnosis

RATIONALE AND OBJECTIVES: Automated detection and quantification of arterial calcifications can facilitate epidemiologic research and, eventually, the use of full-body calcium scoring in clinical practice. An automatic computerized method to detect calcifications in CT scans is presented. MATERIALS AND METHODS: Forty abdominal CT scans have been randomly selected from clinical practice. They all contained contrast material and belonged to one of four categories: containing "no," "small," "moderate," or "large" amounts of arterial calcification. There were ten scans in each category. The experiments were restricted to the vertical range from the point where the superior mesenteric artery branches off of the descending aorta until the first bifurcation of the iliac arteries. The automatic method starts by extracting all connected objects above 220 Hounsfield units (HU) from the scan. These objects include all calcifications, as well as bony structures and contrast material. To distinguish calcifications from non-calcifications, a number of features are calculated for each object. These features are based on the object's size, location, shape characteristics, and surrounding structures. Subsequently a classification of each object is performed in two stages. First the probability that an object represents a calcification is computed assuming a multivariate Gaussian distribution for the calcifications. Objects with low probability are discarded. The remaining objects are then classified into calcifications and non-calcifications using a 5-nearest-neighbor classifier and sequential forward feature selection. Based on the total volume of calcifications determined by the system, the scan is assigned to one of the four categories mentioned above. RESULTS: The 40 scans contained a total of 249 calcifications as determined by a human observer. The method detected 209 calcifications (sensitivity 83.9%) at the expense of on average 1.0 false-positive object per scan. The correct category label was assigned to 30 scans and only 2 scans were off by more than one category. Most incorrect classifications can be attributed to the presence of contrast material in the scans. CONCLUSION: It is possible to identify the majority of arterial calcifications in abdominal CT scans in a completely automatic fashion with few false positive objects, even if the scans contain contrast material.     

Three-dimensional quantification of human standing posture

Accurate but simple and inexpensive assessment of human posture is a requirement of many clinicians, yet a system to do this task is not available. Thus the purposes of this study were to design and build a computerized system for the three-dimensional quantification of the human erect standing posture, to assess the reliability of the developed system, and to present parameters to quantify standing posture. Reflective markers were used to highlight 24 body landmarks of 20 male subjects. Each subject stood on a Kistler force plate while a computer captured images from three standard PAL video camera views and the ground reaction force. Three-dimensional photogrammetric techniques were used to recreate the three-dimensional coordinates of the subjects' landmarks and the location of the line of gravity was determined from the force-plate data. It was concluded that the developed three-dimensional videometric method was reliable and that very small deviations of spinal alignment and trunk rotation as well as leg and arm positions could be detected by the system. Furthermore, eight parameters derived from the landmark coordinates provided valid and reliable inter-day measures of posture.     

Mission, staffing, and budget data of flight programs in the United States

INTRODUCTION: Manage care and other health care reform initiatives have forced all hospitals to evaluate their work processes. In this era of cost containment, many flight programs are examining the structure of their programs to determined whether they are functioning in an efficient, cost-effective fashion. METHODS: A survey was sent to the chief flight nurse of 240 flight programs in the United States. RESULTS: Eighty-five programs (35.4%) responded. Data were collected on demographics, management structure, mission information, staffing issues, and budgets. Results in each program varied widely. CONCLUSION: Benchmark data are available against which programs can compare themselves. Such comparisons may allow the discovery of opportunities to enhance program efficiency and cost-effectiveness.     

CT of carcinoma of the pancreas: Different mode of spread according to lesion site

Thirty-seven patients were evaluated on computed tomography concerning the different modes of spread (peripancreatic vascular invasion and peritoneal implanting) in the pancreatic carcinoma arising in the four anatomic segments. Each was graded from 0 to 3. The median diameter of the adenocarcinomas was 4.5 cm. It was found that high propensity for vascular invasion occurred in the carcinomas of the body and neck, probably due to the anatomical proximity of the these structures, and the high incidence of intraperitoneal seeding in the carcinomas of the tail was found probably because of its intraperitoneal location.     

The development of occupational standards in the practice of diagnostic ultrasound: Part 1, background

This, the first of two papers considers the development of occupational standards in the practice of diagnostic ultrasound, giving an overview of the background to the project which was commissioned by the NHS Executive South and West and the College of Radiographers. The paper provides a review of the literature related to occupational standards with key themes, such as the role of professional bodies in monitoring practice and practitioners and the derivation and definition of occupational standards. Other models and projects which have developed methods of standards design in areas of radiography and diagnostic ultrasound (such as the development of competency based standards for medical radiation science professions) are also considered. The paper concludes with a reflection on the need for continual evaluation of occupational standards and their use in practice.     

Moment acting at the metatarsophalangeal joints during normal barefoot level walking

The functional role of the moments acting at the metatarsophalangeal joints of the foot during bipedal human locomotion is discussed in relation to the time sequence of the foot contact events of the both feet and to the controllability of the angular momentum of the whole body. The moment was measured in normal barefoot level walking for two adult subjects, in both steady state and initiation of walking. The results showed that the maximum metatarsophalangeal moment is as large as one-fifth to one-third of the maximum plantarflexion ankle joint moment. Thus it is demonstrated that the metatarsophalangeal moment plays an important role in controlling the angular momentum of the whole body in the late stage of the single-support phase and early stage of the double support phase.     

Cystic primary neoplasms of the liver of the adult CT features

Although rather rare, primary cystic neoplasms of the liver of the adult may represent a diagnostic challenge in everyday practice. We describe the features of such tumors visualized on computed tomography. This shows a wide range of morphological changes such as septa, papillary growths, solid/liquid ratio, wall characteristics, and vascularization. We conclude that although the differential diagnosis between these tumors and nontumoral cystic lesions may occasionally be reliable on computed tomography, proper management of hepatic cystic neoplasms still relies on the pathological findings.     

Clinical and radiographic evaluation of the acromioclavicular joint

The acromioclavicular (AC) joint is a diarthrodial joint. It is only one of the five joints that make up the complexarrangement of the shoulder. Together with the sternoclavicular joint, the AC joint provides the upper extremity with a connection to the axial skeleton. Injuries to the acromioclavicular joint are very common in athletes and are a source of significant morbidity. AC pathology particularly affects athletes whose sport demands overhead upper limb activity. These problems are most frequently encountered in contact sports, are far more common in males, and may be responsible not only for aesthetically unpleasant deformities of the clavicle, but also for pain, fatigue, and muscular weakness. The treatment of injuries to the AC joint has been controversial since the time o£ Hippocrates¹ (460 to 377 B.C.). The classification by Rockwood has been accepted and there are six types.² Many treatment options have been proposed in the literature, targeted toward the different types of injuries, but it is difficult to compare the different series. The understanding of the anatomy, as well as accurate clinical diagnosis, is critical for the development of a successful treatment plan for both injuries and degenerative changes that may occur in the AC joint. AC joint pain may masquerade as other conditions in the shoulder, therefore, the pathology must be thoughtfully sought out. Careful clinical examination and basic radiographic imaging helps direct a clinically and cost effective approach to these problems.     

Influence of bandage material on pressure distribution under the bandage on the distal forelimb of the galloping horse

Bandaging of thoroughbred race horses is very common. Bandaging is used for prevention of abrasion and support purposes. The support function of different bandage materials and bandage configurations has been quantified in the literature by in-vitro energy absorption studies. How far the measured energy absorption is significant from a physiological point of view and to what force underneath a bandage it translates during galloping is unknown. The purpose of this study was to investigate the influence of bandaging and the influence of bandage material on the kinematics of the forelimb of the galloping horse and to compare the pressure distribution underneath bandages of different materials. The results of the kinematic part of the study are reported elsewhere (Kobluk et al., unpublished). Seven mature thoroughbred race horses were investigated with six different bandages during standing (before and after a trial) and during galloping in an unfatigued and a fatigued condition on a high-speed treadmill. Pressure distribution was collected from a capacitive 21-sensors measurement mat placed underneath the bandage on top of the fetlock joint at a sampling frequency of 100 Hz. The results indicate that the pressures and forces underneath the bandage are high (up to 14.4 N cm⁻², 290 N respectively) and that they increase from unfatigued to fatigued galloping as quantified by heart rate. The behaviour of the investigated bandages showed significant differences between them. Some bandages exhibited forces and pressures that might restrict the blood flow.     

Pseudoaneurysm of the lingual artery

We describe a patient with a false aneurysm of the lingual artery of uncertain etiology and present the ultrasound, computed tomography and angiographic findings.     

Detection and classification performance levels of mammographic masses under different computer-aided detection cueing environments

RATIONALE AND OBJECTIVES: The authors evaluated the impact of different computer-aided detection (CAD) cueing conditions on radiologists' performance levels in detecting and classifying masses depicted on mammograms. MATERIALS AND METHODS: In an observer performance study, eight radiologists interpreted 110 subtle cases six times under different display conditions to detect depicted masses and classify them as benign or malignant. Forty-five cases depicted biopsy-proven masses and 65 were negative. One mass-based cueing sensitivity of 80% and two false-positive cueing rates of 1.2 and 0.5 per image were used in this study. In one mode, radiologists first interpreted images without CAD results, followed by the display of cues and reinterpretation. In another mode, radiologists viewed CAD cues as images were presented and then interpreted images. Free-response receiver operating characteristic method was used to analyze and compare detection performance. The receiver operating characteristic method was used to evaluate classification performance. RESULTS: At these performance levels, providing cues after initial interpretation had little effect on the overall performance in detecting masses. However, in the mode with the highest false-positive cueing rate, viewing CAD cues immediately upon display of images significantly reduced average performance for both detection and classification tasks (P < .05). Viewing CAD cues during the initial display consistently resulted in fewer abnormalities being identified in noncued regions. CONCLUSION: CAD systems with low sensitivity (< or = 80% on mass-based detection) and high false-positive rate (> or = 0.5 per image) in a dataset with subtle abnormalities had little effect on radiologists' performance in the detection and classification of mammographic masses.     

A geologic survey of the medicare RBRVS system

The Resource Based Relative Value System (RBRVS) was established over fifteen years ago in an attempt to bring order to the Medicare reimbursement system. The RBRVS relies on a complicated formula to determine how much each procedure is worth. This article uses an unusual approach to describe the components of the RBRVS equation, how those relative values are developed and managed, and how they relate to each other, even though each one is calculated differently.     

Gait characteristics as a function of age and gender

Sixty male and fifty-eight female subjects ranging in age from 20 to 79 years performed walking at a controlled pace barefoot, wearing standard shoes, and wearing their personal shoes. Additionally these subjects performed walking in the standard shoe at a freely selected speed. Selected kinematic variables for the knee and ankle joint complexes and ground reaction forces were measured in three dimensions to determine differences with respect to age and gender. Additionally a comparison of the path of motion during ground contact and the active range of motion measured in a range of motion fixture were made. A multivariate analysis revealed a number of the kinematic and kinetic variables which were significantly different although the absolute differences were generally small. The comparison of path of motion and range of motion revealed a high correlation for abduction and adduction and plantarflexion and dorsiflexion. It is speculated that changes in gait pattern with increasing age are associated with decreasing muscle strength and a need for increased stability during locomotion with increasing age. The high correlation between path of motion and range of motion is associated with the decrease in muscle strength with increasing age, which is assumed to influence both path of motion and range of motion.     

Detection of the fetus in the cul-de-sac by transabdominal and transvaginal ultrasound a case report

The most common reason for a fetus in the cul-desac is ectopic pregnancy, such as rupture of tuba] pregnancy, orarian pregnancy, and intraabdominal pregnancy (1–3). A case of the fetus in the cul-de-sac complicated by uterine perforation was imaged transabdominally and transvaginally on September 13, 1990.