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BACKGROUND: Proximal femoral nail anti-rotation is widely used in the treatment of femoral intertrochanteric fractures. Accurate screw placement angle and position can effectively improve the success rate of surgery and reduce the incidence of internal fixation-related complications. OBJECTIVE: To investigate the relative anatomical positional relationship between the iliac crest and the greater trochanter of femur on intramedullary nail placement based on radiological measurements. METHODS: 174 hip joints were examined in 87 normal adult pelvic anteroposterior radiographs in Orthopedic Clinic of Guangdong Provincial Hospital of Chinese Medicine. There were 50 males and 37 females at the age of (43.72±14.45) years. The distance between bilateral iliac crest line (La) and bilateral femoral trochanter line (Lb) was measured. The angle with the median pelvic axis ( ∠ 1), the angle between the anatomical axis of the femur and the median axis of the pelvis ( ∠ 2), and the neck-shaft angle ( ∠ 3) were measured. On the pelvic anteroposterior radiograph, the vertical line of the horizontal line of the pelvis was made through the lateral margin of the iliac crest. The exposure of the greater trochanter of the femur was distinguished according to the degree of exposure of the greater trochanter of the femur inside and outside the vertical line. Group I (52 hip joints, with a large degree of exposure) was outside the line, and Group II (122 hip joints, with a small degree of exposure) was inside the line. The iliac crest occlusion angle was Δ1=| ∠ 1- ∠ 2|, and according to the proximal femoral nail anti-rotation with a 5° proximal lateralization angle was grouped, with Δ1 ≤ 5° as group IIa (66 hips), and Δ1>5° as group IIb (56 hips). RESULTS AND CONCLUSION: (1) The values of La, La/Lb and Δ1 in Group I were lower than those in Group II (P < 0.05); the value of La/Lb in Group IIa was higher than that in Group IIb (P < 0.05); the value of Δ1 in Group I was higher than that in Group IIa (P < 0.05) and lower than that in Group IIb (P < 0.05); the value of Lb in Group IIb was lower than that in Group I (P < 0.05) and higher than that in Group IIa (P < 0.05). (2) The results showed that the smaller the distance between the pelvic width and the bilateral femoral trochanters, the smaller the degree of occlusion, and the easier it was to enter the nail. The smaller the degree of iliac crest occlusion, the better for nail insertion was. There are quite a few people with iliac crest occlusion. If it is found that the iliac crest occlusion is obvious before the operation, it can be considered to increase the degree of adduction appropriately to facilitate nail insertion on the premise of maintaining anatomical reduction during positioning, which has guiding significance for clinical operation. [ABSTRACT FROM AUTHOR]

Objective To explore the differences in measurement result of femoral neck shaft angle between anteroposterior X-ray film and 3-dimensional CT reconstruction image, and investigate the main related factors that lead to the differences. Methods The clinical data of 265 lower limbs from 265 patients hospitalized in our center from August 2016 to June 2018 were retrospectively collected from the electronic medical record system of our hospital. The femoral neck shaft angle was measured on the anteroposterior X-ray films and 3-dimensional CT reconstruction images, and the difference was tested. Age, gender, BMI, left and right difference, hip-knee-ankle angle, femoral bowing angle, femoral torsion angle, mechanical lateral distal femoral angle and femoral shaft length were included to establish a statistical model to screen the most important factors leading to the difference. Finally, a control group and an experimental group were set up through the 1:1 propensity score matching to verify the the most important factors. Results The femoral neck shaft angle was (128.02±6.26)° on the anteroposterior X-ray films and (124.22±6.45)° on the 3-dimensional CT reconstruction images, and statistical difference was found between them (P < 0.001), with a difference greater than 3° (accounting for 56.6% of the patients). The established multiple linear regression model (P < 0.001, adjusted R2=0.747) showed that femoral torsion angle (standardized regression coefficient=-0.233, P < 0.001) was the most important factor of the difference. Conclusion There is a difference in the measurement result of femoral neck shaft angle between anteroposterior X-ray film and 3-dimensional CT reconstruction image. Femoral torsion angle is the most important factor. Larger femoral extorsion angle causes larger femoral neck shaft angle measured on the anteroposterior X-ray film.

BACKGROUND: The imaging evaluation of anterior cruciate ligament reconstruction mostly through two-dimensional X-ray has disadvantages of non-solid and large measurement error, while three-dimensional reconstructive CT (3D-CT) has higher accuracy for postoperative evaluation. OBJECTIVE: To evaluate the accuracy of bone tunnel position and graft status after anterior cruciate ligament near-isometric reconstruction measured by 3D-CT and X-ray. METHODS: From January 2016 to December 2019, 31 patients with arthroscopic anterior cruciate ligament reconstruction were selected from the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, including 28 males and 3 females, at the age of 20-47 years. All patients were subjected to anterior medial approach to locate the bone tunnel of femur and anterior cruciate ligament near-isometric reconstruction. 3D-CT and X-ray examination were performed within one week after the operation to observe the condition of graft and bone tunnel. The position of bone tunnel in tibia and femur was measured by Klos method and Bernard method respectively. The trial was approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine. RESULTS AND CONCLUSION: (1) 3D-CT clearly showed the bone tunnel after anterior cruciate ligament reconstruction. The 31 patients had complete bone tunnel wall, (21.71±2.16) mm for femoral end graft and (14.23±1.78) mm for tibial end graft (excluding extrusion screw part). The internal fixator and graft ligament could also be observed. (2) X-ray films showed that the position of tibial tunnel was (44.17±5.23)% in sagittal plane and (43.05±4.58)% in coronal plane. The position of femoral tunnel was (28.75±4.59)% in Blumensaat line level and (38.23±8.71)% in height from the top of intercondylar fossa. 3DCT showed that the position of tibial tunnel was (42.41±6.93)% in sagittal plane and (43.66%±4.12)% in coronal plane; the position of femoral tunnel was (32.41±6.33)% in blumensaat line level and (41.53±6.51)% in height from the top of intercondylar fossa. There was significant difference in tunnel position between the two methods at Blumensaat line level (P=0.011). (3) The results show that there are some differences between 3D-CT and X-ray films in the evaluation of bone tunnel position after anterior cruciate ligament near-isometric reconstruction. 3D-CT measurement can objectively and accurately reflect the condition of bone tunnel and graft state. [ABSTRACT FROM AUTHOR]

Objective: To explore the method of accurately estimating the acetabular cup prosthesis coverage rate (hereinafter referred to as "cup coverage rate") in total hip arthroplasty (THA) based on X-ray films, and to determine the effective parameters that can be used to estimate the cup coverage rate., Methods: The three-dimensional printed pelvic models were established based on CT data of 16 healthy pelvis, and the acetabular prosthesis were implanted according to conventional THA procedure. The length and width of the uncovered area of the acetabular cup prosthesis were measured by a modified X-ray recording method with a rotating C-arm X-ray machine, and the cup coverage rate was calculated. Then the differences among the traditional anteroposterior X-ray recording method, the modified method, and actual measurement on pelvic model were statistically analyzed. The correlation between the area of the uncovered area of the prosthesis and its width and length was analyzed by using multiple linear regression analysis., Results: The cup coverage rates of traditional method, modified method, and actual measurement were 78.22%±3.36%, 86.74%±3.61%, and 89.62%±2.62%, respectively, with significant differences ( P <0.05). The results of multiple linear regression analysis showed that the width and length were positively linear with the uncovered area of the prosthesis, and the regression equation was as follows: uncovered area of the prosthesis=-21.192+0.248×width+0.140×length, and the coefficient of determination R 2 =0.857, P <0.001., Conclusion: Compared with the traditional method, the modified method can more accurately evaluate the cup coverage rate during THA, and the width of the uncovered area of the prosthesis can be used as an effective reference for the cup coverage rate.

Objective: To propose a method to determine the unreasonableness of the fixed angle in posterior atlantoaxial fusion surgery based on the ratio of line segments between anatomical landmarks of the atlantoaxial joint. Methods: A cross-sectional study was conducted. According to the inclusion criteria, a screening was performed on the database of asymptomatic volunteers who had full-spine lateral X-ray films taken at the Second Affiliated Hospital of Wenzhou Medical University from May 2016 to May 2021. A total of 207 volunteers were included, comprising 98 males with an age of (40.68±13.87) years and 109 females with an age of (42.64±14.45) years. On the lateral X-ray film, a line (L) parallel to the posterior margin of the odontoid process was drawn at the posterior edge of the lower articular surface of the axis (a), intersecting the atlas at points b, c, and d. The line segments ab, bd, bc, and the C 1 -C 2 angle were measured, and the ratios of bd/ab and bc/ab were calculated. The ability of bd/ab and bc/ab to predict the unreasonable fixed angle of the atlantoaxial joint (≥22°) was analyzed by receiver operating characteristic (ROC) curve analysis in both male and female. The areas under the ROC curves (AUC) were calculated, and the performance of the two prediction methods was compared using the Delong's test. The cutoff value for distinguishing the unreasonableness of the C 1 -C 2 angle and the sensitivity and specificity were calculated. Results: The ROC curve analysis in the male group showed that the AUC of bc/ab for predicting the unreasonable C 1 -C 2 angle was 0.791 (95% CI : 0.696-0.867, P <0.001), with a cutoff value of 0.449, sensitivity of 97.3%, and specificity of 70.0%. The performance was significantly better than that of bd/ab (cutoff value 1.100, AUC=0.532, 95% CI : 0.428-0.634, sensitivity 26.3%, specificity 83.3%, P <0.001). The ROC curve analysis in the female group showed that the AUC of bc/ab for predicting the unreasonable C 1 -C 2 angle was 0.804 (95% CI : 0.745-0.852, P <0.001), with a cutoff value of 0.488, sensitivity of 90.5%, and specificity of 58.6%. The performance was significantly better than that of bd/ab (cutoff value 0.960, AUC=0.687, 95% CI : 0.624-0.748, sensitivity 90.5%, specificity 44.8%, P =0.041). Conclusions: The bc/ab value can be used as an effective indicator to predict the unreasonable C 1 -C 2 angle in posterior atlantoaxial fusion surgery with high diagnostic accuracy. The cutoff value for males is<0.449, and for females is<0.488.

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This study was aimed to determine the most effective horizontal beam angulation to identify 4 canals in the mandibular first molars, so as to provide full and accurate information for the clinic. METHODS: One hundred and twenty mandibular first molars with four canals that needed endodontic treatment in vivo were selected. Radiographs were taken at horizontal angles of 0,10,20 degrees from distal direction and 0,10,20,30 degrees from mesial direction of the tooth. The numbers of root canal and the degree of resolution were identified and recorded by 3 independent observers. Data were analyzed using SPSSIO.O software package or Chi-square test. RESULTS: At 30 and 20 degrees from mesial direction, 93.3% and 90.0% of all the 120 teeth were correctly identified as 4 canals, compared with 0 degree of 40.0%( P<0.01). Of them, 71.5% and 89.7% could be classified as with high resolution, respectively. The latter was not significantly lower than 0 degree of 95.0% (P>0.05). CONCLUSION: Twenty degrees from mesial direction is the most effective X-ray beam angle in diagnosing 4 canals of the first mandibular molars. [ABSTRACT FROM AUTHOR]

Objective: To analyze the preoperative influencing factors of varus after Oxford unicompartmental knee arthroplasty., Methods: A total of 660 patients (767 knees) undergoing Oxford unicompartmental knee arthroplasty in adult joint reconstruction surgery department of Beijing Jishuitan Hospital from January 2018 to December 2019 were retrospectively analyzed. Inclusive criteria: diagnosis was osteoarthritis, single compartment lesions in the medial side of the knee; preoperative flexion deformity was less than 10°, active range of motion was greater than 90°; preoperative X-ray full-length images of both lower limbs showed less than 15° varus (Noyes method); anterior cruciate ligament was well functioned, The cartilage of lateral compartment of knee joint was intact., Exclusion Criteria: combined with other inflammatory arthropathy; combined with extraarticular deformity; previous knee surgery history. The average age of the patients was (64.4±8.1) years, including 153 males and 497 females. The degree of post-operative varus was measured with Noyes method. The total patients were divided into varus group (Noyes≥3 °) and normal group (Noyes < 3 °). Gender, age, body mass index (BMI), range of motion (ROM), preoperative flexion deformity (FD), American Knee Society pain score (AKS) and American Knee Society function score (AKS function) were recorded. The standard anteroposterior and lateral X-ray films of knee joint and full-length lower extremity kinematic line films were taken by Sonialvision Safine Ⅱ (Shimadzu, Japan) multi-function digital tomography system. The image was measured by picture archiving and communication system (PACS). The following angles were measured preoperative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line converge angle (JLCA) were measured and analyzed., Results: Gender( P =0.346), operative side ( P =0.619), age ( P =0.746), BMI ( P =0.142), preoperative ROM ( P =0.102), preoperative knee pain score ( P =0.131) and functional score ( P =0.098) were not risk factors for postoperative varus. The influencing factors of postoperative varus were preoperative MPTA < 84 ° ( P = 0.018, OR = 3.712, 95% CI : 1.250-11.027), preoperative Noyes > 5°( P =0.000, OR = 3.105, 95% CI : 1.835-5.254), preoperative FD > 5° ( P = 0.001, OR =1.976, 95% CI : 1.326-3.234). Pre-operative LDFA ( P =0.146) and preoperative JLCA ( P = 0.709) had no significant effect on postoperative kinematic line., Conclusion: Patients with severe preoperative varus, especially those with varus deformity mainly from the tibial side, and those with preoperative flexion deformity are more prone to get varus lower extremity kinematic line after Oxford unicompartmental knee arthroplasty.

Objective: To discuss the feasibility and accuracy of distal femoral patient-specific cutting guide in total knee arthroplasty (TKA) based on knee CT and full-length X-ray film of lower extremities., Methods: Between July 2016 and February 2017, 20 patients with severe knee joint osteoarthritis planned to undergo primary TKA were selected as the research object. There were 9 males and 11 females; aged 53-84 years, with an average of 69.4 years. The body mass index was 22.1-31.0 kg/m 2 , with an average of 24.8 kg/m 2 . The preoperative range of motion (ROM) of the knee joint was (103.0±19.4)°, the pain visual analogue scale (VAS) score was 5.4±1.3, and the American Hospital of Special Surgery (HSS) score was 58.1±11.3. Before operation, a three-dimensional model of the knee joint was constructed based on the full-length X-ray film of lower extremities and CT of the knee joint. The distal femoral patient-specific cutting guide was designed and fabricated, and the thickness of the distal femoral osteotomy was determined by digital simulation. The thickness of the internal and external condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy were compared. The intraoperative blood loss, postoperative drainage loss, and hidden blood loss were recorded. The ROM of knee joint, VAS score, and HSS score at 3 months after operation were recorded to evaluate effectiveness. The position of the coronal and sagittal plane of the distal femoral prosthesis were assessed by comparing the femoral mechanical-anatomical angle (FMAA), anatomical lateral distal femoral angle (aLDFA), mechanical femoral tibial angle (mFTA), distal femoral flexion angle (DFFA), femoral prosthesis flexion angle (FPFA), anatomical lateral femoral component angle (aLFC), and the angle of the femoral component and femoral shaft (α angle) between pre- and post-operation., Results: TKA was successfully completed with the aid of the distal femoral patient-specific cutting guide. There was no significant difference between the thickness of the internal and lateral condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy ( P >0.05). All patients were followed up 3 months. All incisions healed by first intention, and there was no complications such as periarticular infection and deep vein thrombosis. Except for 1 patient who was not treated with tranexamic acid, the intraoperative blood loss of the rest 19 patients ranged from 30 to 150 mL, with an average of 73.2 mL; the postoperative drainage loss ranged from 20 to 500 mL, with an average of 154.5 mL; and the hidden blood loss ranged from 169.2 to 1 400.0 mL, with an average of 643.8 mL. At 3 months after operation, the ROM of the knee was (111.5±11.5)°, and there was no significant difference when compared with the preoperative one ( t =-1.962, P =0.065). The VAS score was 2.4±0.9 and HSS score was 88.2±7.5, showing significant differences when compared with the preoperative ones ( t =7.248, P =0.000; t =-11.442, P =0.000). Compared with the preoperative measurements, there was a significant difference in mFTA ( P <0.05), and there was no significant difference in aLDFA, FMAA, or DFFA; compared with the preoperative plan, there was no significant difference in FPFA, aLFC, or α angle ( P >0.05)., Conclusion: The use of distal femoral patient-specific cutting guide based on knee CT and full-length X-ray film of lower extremity can achieve precise osteotomy, improve coronal and sagittal limb alignment, reduce intraoperative blood loss, and obtain satisfactory short-term effectiveness.

As an important tool for assessing musculoskeletal conditions, imaging plays an important role in assessing the risk of disease, judging disease and the progress of disease, and prognosis scores. Accompanied with the rapid development of artificial intelligence(AI) in the field of image detection and interpretation, some AI-assisted recognition studies involving musculoskeletal X-ray imaging have been examined and shown a high potential value, which can enhance various parts of the X-ray imaging value chain and guide clinicians by improving imaging efficiency, imaging quality, and diagnostic accuracy. At present, the development of AI-assisted imaging recognition technology is still at an early stage. AI algorithms need to be further improved and developed. Image data is still insufficient and the qualityis relatively heterogeneous. The long-term accuracy and stability of technical performance require further observation and research.

Objectives: To realize the automated bone age assessment by applying deep learning to digital radiography （DR） image recognition of left wrist joint in Uyghur teenagers, and explore its practical application value in forensic medicine bone age assessment., Methods: The X-ray films of left wrist joint after pretreatment, which were taken from 245 male and 227 female Uyghur nationality teenagers in Uygur Autonomous Region aged from 13.0 to 19.0 years old, were chosen as subjects. And AlexNet was as a regression model of image recognition. From the total samples above, 60％ of male and female DR images of left wrist joint were selected as net train set, and 10％ of samples were selected as validation set. As test set, the rest 30％ were used to obtain the image recognition accuracy with an error range in ±1.0 and ±0.7 age respectively, compared to the real age., Results: The modelling results of deep learning algorithm showed that when the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the net train set was 81.4% and 75.6% in male, and 80.5% and 74.8% in female, respectively. When the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the test set was 79.5% and 71.2% in male, and 79.4% and 66.2% in female, respectively., Conclusions: The combination of bone age research on teenagers' left wrist joint and deep learning, which has high accuracy and good feasibility, can be the research basis of bone age automatic assessment system for the rest joints of body., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Forensic Medicine.)

Objectives: To establish regression models of stature estimation for Sichuan Han female by the measurement of total vertebral column length in the frontal and lateral X-ray films of whole-spine., Methods: The frontal and lateral X-ray films of whole-spine were collected from 200 Sichuan Han females by large flat-panel multi-functional universal radiography and fluoroscopy system. The data and mean values of frontal and lateral total vertebral column length were measured and calculated in all the samples, respectively. The relationship of combined multi-markers and stature were analysed by linear regression analysis, and the mathematical models of stature estimation were established. The data of 30 new samples were selected and inputted for verifying the accuracy of the mathematical models., Results: The total vertebral column length showed a good correlation with stature, and the mean values of the frontal and lateral X-ray films of total vertebral column length had the highest correlation coefficients. Three established linear regression equation models were statistically significant （ P <0.05）, and the equation established with lateral total vertebral column length showed the highest accuracy., Conclusions: The stature estimation by the measurement of total vertebral column length has high accuracy., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Forensic Medicine.)

Objectives: To explore the correlation between the imaging parameters of skull and the external features of eyes., Methods: Positive images of the head face and the frontal and lateral X-ray films were obtained from 101 cases of adult males of the Han nationality aged from 20 to 40 years old in Northeast China. The face width （ x ₁）, upper face width （ x ₂）, biorbital width （ x ₃）, all facial height （ x ₄）, upper facial height （ x ₅）, maximum breadth of skull （ x ₆）, minimum breadth of frontal bone （ x ₇）, orbital widthⅡ（ x ₈）, anterior interorbital breadth （ x ₉）, maximum height of skull （ x ₁₀）, minimum width of nasal bone （ x ₁₁） and orbital height （ x ₁₂） were measured and the data were statistically analysed., Results: Through the linear regression analysis, the regression equations of the presumed inboard canthi （ y ₁） and outboard canthi distances （ y ₂） were established, respectively, which were y ₁=0.025 x ₂+0.291 x ₃-0.011 x ₇+0.041 x₁₀-0.525（ R =0.613, SEE =0.222 cm） and y ₂=1.703-0.08 x ₂+0.573 x ₃-0.142 x ₄+0.421 x ₅+0.096 x ₇-0.256 x ₈+0.149 x ₉+0.071 x ₁₀（ R =0.745, SEE =0.341 cm）. The back-substitution check showed that the accuracy rate of two equations at ±1 SEE were 75.2% and 80.2%, respectively., Conclusions: The established regression equations of external features of eyes have high estimation accuracy, which can be used to the practical work of facial reconstruction., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Forensic Medicine)

Objective: To review the clinical research on the main drugs which are used to treat pneumoconiosis in China, evaluate and analyze the efficacy, and give the suggestions on the study of pneumoconiosis treatment. Methods: The data of researches on the therapeutic effects of eight main drugs on patients with pneumoconiosis in China were retrieved from CNKI and Wanfang database before Jan. 1, 2016 including polyvinylpyridine, tetrandrine, piperaquine phosphate, hydroxypiperaquine phosphate, aluminium citrate, Xinin, Xifeining and N-acetyl cysteine (NAC) after consulting the related project files on the clinical treatment on the patients with pneumoconiosis, and a systematic analysis was made on the random control test (RCT) which conformed to the quality criteria in terms of five indices such as the improvement rate of respiratory system symptoms such as cough, expectoration, chest pain and dyspnea, the decrease of the respiratory system infection rate, the changes in FEV 1.0 % (forced expired volume in one second to forced vital capacity ratio) (ΔFEV 1.0 %) , index of stability and improvement rate of chest X-ray, and adverse reactions as well as the summary of descriptive efficacy. Results: Nine RCTs in the 15 papers were included; 2 097 patients with pneumoconiosis were included with 1215 in the treatment group and 882 in the control group. The medication modes were divided into four categories, monotherapy (such as polyvinylpyridine, hydroxypiperaquine phosphate, Xifeining and Xinin) , combination of tetrandrine with other drugs, hydroxypiperaquine phosphate and aluminium citrate, and lung lavage (added medications) ; the analysis indicated that the patients in the treatment group were obviously superior to those in the control group in terms of the improvement rate of respiratory system symptoms, the decrease rate of the respiratory tract infection, ΔFEV 1.0 %, the improvement rate of shadows as indicated in the X-ray chest film and the index of stability ( P <0.01) ; after the mean values of the control group were deducted, the improvement rate of symptoms of the respiratory system within the treatment period of the patients with pneumoconiosis increased by 34.6% (95% CI 32.9%, 36.3%) in average, the mean value of the decrease in the respiratory tract infection rate was 26.0% (95% CI 24.0%, 28.0%) , the mean value of ΔFEV 1.0 % was 4.08 (95% CI 3.56, 4.60) , the improvement rate in X-ray chest film increased by 8.80% (95% CI 8.55%, 9.05%) in average, and the index of stability in the X-ray chest film increased by 10.6% (95% CI 9.18%, 12.0%) ; one-way analysis of variance indicated the presence of statistical difference in terms of efficacy of four categories of medication modes ( F the improvement rate of symptoms of the respiratory system =482.2, P <0.01; F the decrease in the respiratory tract infection rate =72.01, P <0.01; F ΔFEV1.0% =246.6, P <0.01; F the index of stability in the X-ray chest film =212.9, P <0.01; F the improvement rate of X-ray chest film =466.6, P <0.01) . Conclusion: Drugs such as polyvinylpyridine, tetrandrine, hydroxypiperaquine phosphate, aluminium citrate, Xinin, Xifeining and NAC have some efficacy in the treatment of pneumoconiosis. It is suggested that, in accordance with the mechanism of pneumosilicosis onset and the action mechanism of drugs and on the basis of the research on the traditional drugs, the latest clinical study results and the management experiences on the idiopathic pulmonary interstitial fibrosis be constantly traced and borrowed to strengthen the research on the drugs which are used to treat the pneumoconiosis and the patient health management.

Objective: To establish the optimal image post-processing parameters for digital chest radiography as preliminary research for introducing digital radiography (DR) to pneumoconiosis diagnosis in China., Methods: A total of 204 pneumoconiosis patients and 31 dust-exposed workers were enrolled as the subjects in this research. Film-screen radiography (FSR) and DR images were taken for all subjects. DR films were printed after raw images were processed and parameters were altered using DR workstation (GE Healthcare, U.S.A.). Image gradations, lung textures, and the imaging of thoracic vertebra were evaluated by pneumoconiosis experts, and the optimal post-processing parameters were selected. Optical density was measured for both DR films and FSR films., Results: For the DR machine used in this research, the contrast adjustment (CA) and brightness adjustment (BA) were the main parameters that determine the brightness and gray levels of images. The optimal ranges for CA and BA were 115%∼120% and 160%∼165%, respectively. The quality of DR chest films would be optimized when tissue contrast was adjusted to a maximum of 0.15, edge to a minimum of 1, and both noise reduction and tissue equalization to0.The failure rate of chest DR (0.4%) was significantly lower than that of chest FSR (17%) (P < 0.05)., Conclusion: After appropriate image post-processing on DR machine purchased from GE Healthcare, the DR chest films can meet all requirements for the quality of chest X-ray films in the Chinese diagnostic criteria for pneumoconiosis.

Objective: To discuss bone development trend in the knee joint of Tibetan teenagers in Sichuan province and to effectively update the database for estimating the living age of Tibetan teenagers in terms of bone age of the knee joint., Methods: Radiographs including epiphysis of distal femur, proximal tibia and proximal fibula were taken from 483 Tibetan male and female teenagers aged from 14 to 19 years old in Aba prefecture of Sichuan province in order to observe epiphyseal growth situation. The descriptive data of the epiphyseal closure ages of these teenagers' knee joints were statistically analyzed by SPSS 16.0 software., Results: The distal femur epiphyseal closure occurred earliest, while the proximal fibula epiphyseal closure occurred latest. The epiphyseal growth of knee joints of females occurred about one year earlier than that of males., Conclusion: The forensic information and data related to Tibetan teenagers' bone age identification should be updated regularly. These results provide potential value for the practice of forensic medicine, anthropology and clinical medicine.

This paper describes the design process and implementation process of electronic film system. The establishment of electronic film system allowed us to aggressively reduce film use and costs and to demonstrate a positive return.

In this paper, by describing and comparing different implementations of electronic film combined with the actual application of the electronic film in the imaging department and the clinical departments. We elaborate electronic film for optimizing the imaging department workflow to improve service quality and patient satisfaction and other aspects of value.

Objective: To compare the clinical efficacy of grade III, IV supination-eversion fractures-dislocations of ankle joint between manipulative treatment and operative treatment., Methods: From September 2007 to December 2008, the clinical data of 60 patients with grade III, IV supination-eversion fractures-dislocations of ankle joint were retrospectively analyzed. There were 32 males and 28 females, ranging in age from 18 to 70 years with an average age of 38.17 years. All patients were respectively treated with manipulative treatment (conservative group, 30 cases) and operative treatment (operative group, 30 cases). The joint function was compared with Mazur standard; the reduction and shifting of fractures were observed with X-ray; the hospitalization day and the therapeutic cost were compared between two groups., Results: All patients were followed up with an average of 15.27 months (ranged, 6 to 25 months). In conservative group, 16 cases got excellent result in joint function, 10 good, 3 fair, 1 poor; in operative group, 20 cases got excellent result, 8 good, 2 fair, 0 poor. In conservative group in the X-ray showed 25 cases obtained excellent and good reduction, 4 fair, 1 poor; and in operative group in the X-ray showed 28 cases obtained excellent and good reduction, 2 fair, 0 poor. There was no significant difference at the joint function and X-ray film after treatment between two groups (P > 0.05). The hospital day was respectively (7.87 +/- 3.34), (17.37 +/- 4.64) d in conservative group and operative group; and the therapeutic cost was respectively (2 506.67 +/- 649.10), (11 473.33 +/- 1 564.90) yuan. There was significant difference at hospital day and therapeutic cost between two groups (P < 0.05)., Conclusion: Conservative treatment and operative treatment can both reach a very good result in treating grade III, IV supination-eversion fractures and dislocations of ankle joint. However, conservative treatment has advantage of high safety factor, low therapeutic cost, can reduce medical costs for patients.

Age estimation by the measurement method is to get the data such as the length, width, thickness, area of the ossification center, transverse diameter of the metaphysis, transverse diameter of osteoepiphysis, width of the epiphyseal line and the ratio between the diaph and the epiphyseal, by measuring the different bones of human in different ages with the radiological technology and to explore the relationship between these data and the life age by statistics. According to the relationships the personal life age may be estimated. In this article the measurement methods above mentioned and its application in age estimation were reviewed.

Purpose: To analyze the effect of topical anesthetics in taking dental X-ray film., Methods: 300 patients, who needed to take dental X-ray photography of maxillary or mandibular molar were randomly assigned to 3 groups. Bisecting angle technique was used to take the film. Before taking the X-ray, the throats of the patients in Group I were treated by 1% dyclonine spraying anesthesia, Group II were treated by FRILJET local cryoanesthesia and pulp vitality test agent, and Group III were set as control. The anesthesia efficiency and imagine quality of the dental films were evaluated, and the anesthetic time was recorded. The data was analyzed with ANOVA and Chi-square test using SPSS12.2 software package., Results: The anesthesia efficiency was 99% in group I, 98% in Group II, and 62% in Group III. The imagine quality in Group I and II was higher than that in Group III. For both anesthesia efficiency and imagine quality, there was no significant difference between Group I and Group II, but there was significant difference between Group I and Group III, and between Group II and Group III (P<0.01).Significant difference of anesthetic time was showed between Group I and Group II . Compared with Group II, longer time(4 minutes) was needed in Group I to show the anesthetic effect, and it lasted longer for 21.62+/-3.54 minutes; while in Group II, the anesthetic effect lasted shorter, only for 2.07+/-1.22 minutes, but it developed immediately., Conclusion: The use of local anesthetics improves the accuracy, quality, and success rate in taking dental X-ray films.

Objective: To investigate the effects of occupational lead exposure on lumbar vertebral fracture in exposed male workers., Methods: One hundred and fifty-two lead-exposed male workers in a storage battery plant in Shanghai were selected as the study population. The blood lead (BPb) and the urinary lead (UPb) were measured by graphite-furnace atomic absorption spectrometry (GF-AAS). Bone mineral density (BMD) was measured by the monophoton absorptiometry(SPA-4) and Z score was determined. Anteroposterior and lateral lumbar spinal X-ray films were taken to determine lumbar vertebral fracture., Results: For the occupationally lead-exposed workers, geometric mean of BPb was 0.85 (0.33 approximately 1.90) micromol/L, geometric mean of UPb was 4.84 (0.46 approximately 21.31) microg/g Cr, and the prevalence of lumbar vertebral fracture was 19.7%. The prevalence of lumbar vertebral fracture would increase with the increase of age and work year, but with no significantly statistical difference (P > 0.05). The bone mineral density (BMD) would decrease with the increase of BPb and UPb (P < 0.05). The prevalence of lumbar vertebral fracture would increase significantly with the increase of the lead exposure (P < 0.05) with the linear correlation (P < 0.05). The prevalence of lumbar vertebral fracture would increase significantly with the decrease of the bone mass (P < 0.01) with the linear correlation (P < 0.01)., Conclusion: The occupational exposure to lead could cause the decrease of the bone mineral density and the increase of the prevalence of lumbar vertebral fracture. The development of lumbar vertebral fracture is associated with the decrease of bone mass.

The traditional methods of skeletal age estimation mainly include Numeration, Atlas, and Counting scores. In recent years, other new methods were proposed by several scholars. Utilizing image logical characteristics of X-ray film to extrapolate skeletal age is a key means by present forensic medicine workers in evaluating skeletal age. However, there exist some variations when we present the conclusion of skeletal age as an "evidence" directly to the Justice Trial Authority. In order to enhance the accuracy of skeletal age determination, further investigation for appropriate methodology should be undertaken. After a collective study of pertinent domestic and international literatures, we present this review of the research and advancement on skeletal age evaluation methods of X-ray film.

Objective: To observe the outcome of the fractured immature anterior permanent teeth after pulpotomy by X-ray measurement., Methods: A total of 31 (25 cases) fractured immature anterior permanent teeth after pulpotomy was reviewed. Radiographic measurements were performed on 12 cases with unilateral fractured central incisors and completely formed roots after pulpotomy and 100 (50 subjects) healthy maxillary central incisors., Results: The roots development continued after pulpotomy, and the root length and periapical configuration were both similar to the healthy teeth, but some root canals became narrow or even nearly obturated at the root apex. There was no significant difference in root canal width between healthy right and left maxillary central incisors at the site of 1/4 [right: (0.67 +/- 0.14) mm, left: (0.66 +/- 0.12) mm, P > 0.05], 1/2 [right: (1.05 +/- 0.19) mm, left: (1.04 +/- 0.17) mm, P > 0.05], 3/4 [right: (1.78 +/- 0.34) mm, left: (1.76 +/- 0.30) mm, P > 0.05] of root, but the root canal width of the fractured incisors at the same site was significantly different from that of the contralateral healthy incisor, the 1/4 site pulpotomy: (0.70 +/- 0.23) mm, control: (0.99 +/- 0.17) mm, the 1/2 site pulpotomy: (1.16 +/- 0.24) mm, control: (1.51 +/- 0.25) mm; the 3/4 site pulpotomy: (1.96 +/- 0.34) mm, control: (2.24 +/- 0.36) mm., Conclusions: There was a tendency that the root canals of fractured teeth after pulpotomy became narrowed and obturated. It should not be followed up for too long to perform root canal treatment when roots completely formed.

This paper is to approach a simple method for Wiener spectrum measurement in different medial imaging systems. The program written in VC++6.0 can be used to obtain the density datum as discrete signals by scanning films on AGFA DUOSCAN T2000XL scanner, then WS values can be calculated by using fast Fourier transform. The method is applied to different x-ray photographs and the WS values are consistent with the known datum from MD-100 micro-densimeter. The method can make automatic data collection and procedural calculation, showing the characteristics of its simplicity and high speed.

Objective: To explore the radiological diagnosis of primary malignant fibrous histiocytoma (MFH) of bone., Methods: Sixteen patients with biopsy-or surgery-confirmed MFH received both plain X-ray and CT examinations, among whom six patients simultaneously received MRI. The imaging features were analyzed and the differential diagnoses were assessed., Results: (1) Plain X-ray findings: All these lesions showed irregularly osteolytic, accompanied by cortical destruction. Five patients had varied degrees of cortical expansion, 12 had large soft tissue masses adjacent to the lesions, and only 2 had periosteal reaction. (2) CT findings: All lesions were osteolytic areas but had no evidences that its internal architecture had been replaced by soft tissue mass, and the cortical adjacent to the lesions were permeative osteolysis. Four patients had internal or marginal crest within the lesions and marginal inconsecutive osteosclerosis. Twelve had large soft tissue masses but without any calcification and residual architecture adjacent to the lesions, among which 3 patients had solitary or multiple cystic attenuation areas within the masses. No clear periosteal reaction was observed on CT. (3) MRI findings: All of lesions in 6 patients who received MRI showed inhomogeneous long T1 and long T2 abnormal signal intensity with soft tissue masses adjacent to the osteo-destructions., Conclusions: The imaging manifestations of MFH were specific to some extent. Combined utilization of plain X-ray, CT, and MRI is helpful for the diagnosis and differential diagnosis of MFH.

Objective: To explore an approach of CT rendering and mechanical analysis for rib fracture that was inextricable on X-ray film in legal medical practice., Methods: 17 cases with rib fracture undetermined on X-ray chest film in legal medical practice underwent CT scans. The thin slices (0.75 mm or lmm) of images were reconstructed with smooth and sharp kernel. The multiplanar reformatted images along rib and surface shaded display were obtained to investigate rib fracture., Results: All rib fractures were accurately displayed by CT scan and MPR images along rib. The torque that caused rib fracture was divided presumably into vertical and rotary types. The two kinds of rib fracture, composed of vertical and rotary type, were proposed., Conclusion: CT scan with thin slice and MPR images can definitely reveal the rib fracture unresolved on X-ray film in legal medical practice. The proposition of two kinds of torque will be help avoid misunderstanding acute rotary type of rib fracture as old healed one.

Objective: The purpose of this study was to observe the roentgenographic characters of distraction osteogenesis (DO) correction of cleft palate (CP), to study the expression of BMP proportional to fixation period time intervals, and to explore the new bone formation mechanism in Cleft Palate bone shelf., Methods: 12 cats were used to establish the CP animal model surgically, and then were assigned randomly to (1) Experimental group (12 cats): CP defects were DO repaired at the rate and rhythm of 0.4 mm x 2/day. Specimen retrieval at 2, 4, 6, 8, 12 weeks after completion of distraction, roentgenography and Anti-BMP immunohistochemistry studies were performed; (2) Experimental control group (2 cats): CP defects without any treatment procedures, and (3) Empty control group of 2 cats., Results: Anti-BMP immunohistochemistry study showed positive DAB dye in early 2 weeks and most extensively positive expression of BMP in 4 to 6 weeks. The expression of BMP wore off gradually through 8 to 12 weeks. The roentgenography showed that the newly mineralized bone was developed from the cut bone edges bilaterally to the central transparent zone, and the newly formed bone bridged the defect area completely at the end of the study. The CP bone defect was reconstructed and the distraction gap was filled with de nove osteogenesis. No new bone formation was observed in experimental control group., Conclusion: The process of new bone formation in the distraction area is dynamic. Being stimulated primarily, the process was kept highly active till quiescence phase finally. The X-ray examination shows that there is distinctively low roentgenopeque. Nevertheless, roentgenography is so far a very effective and convenient method to evaluate and monitor the DO correction efficiency.

This article introduces three different marking technologies used in clinical radiation photography at present and their respective theories, their advantages and disadvantages, analyzes the space-time and technology conditionality of different marking technologies in selecting mark messages. In the future, new marking technology will be fused with the cassette into one and will contain message as much as possible on photograph marks in order to satisfy the need of technicians and doctors.

Objective: To evaluate the cochlear implant operation by the use of X-ray or CR., Method: There are 15 ears 15 cases which were completed the cochlear implant operation, after operation the implant electrode array was shown by the use of X-ray or CR., Result: The shape and station of those were normal, average insered depth was 23.05 mm, come up to provide standard., Conclusion: It was an economic, convenient, objective and worthy method to evaluate the cochlear implant.

This paper introduces a multiple-point detecting technique of the density of dental X-ray films. With the infrared ray multiple-point detecting technique, a single-chip microcomputer control system is used to analyze the effectiveness of the film-developing in real time in order to achieve a good image. Based on the new technology, We designed the intelligent automatic dental X-ray film processing.

The results on the agreement between microcomputer and experts for the diagnosis of pneumoconiosis from X-ray films are presented in this paper. On a set of 200 films, the diagnoses made by the computer and by five experts were compared; From 100 films, the agreement rates were 83.5% for the normal/abnormal, 73.0% for the four categories of profusion and 70.5% for the four categories of pneumoconiosis. From 100 films, the rates of agreament between the computer and the basic-level consultation group were 86.0%, 82.0% and 63.0% respectively. From 300 films for screening pneumoconiosis, the rate of agreement between the computer and the experts was 89.3%. The results demonstrate that the automatic diagnosis by computer is closer to the diagnosis made by experts.

Based on the lung anatomy, the border of lung zone is expressed as a set of parabolic and straight lines. After several feature points are detected, the parameters of the lines are determined and the lung zone in X-ray film is recognized. A coarse-to-fine strategy is employed in the procedure to lower the computation consuming. The method has been successfully used in an application system.