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Background: The National Healthcare Service (NHS) radiology service delivery in London is representative of the current pressures and challenges faced in England of Musculoskeletal (MSK) X-ray reporting workforce shortages, and national turnaround time (TATs) targets. The implementation project evaluated facilitation as a strategy to achieve the NHS England 50% target for all MSK X-rays to be reported by radiographers., Methods: The project was an eight-month multi-centre (n = 5 London NHS Trusts) study applying the Promoting Action on Research Implementation in Health Services (PARIHS) framework with embedded mixed-methods evaluation. Initial observational data using the Context Assessment Index (CAI) tool and the Workplace Culture Critical Analysis Tool (WCCAT) set the implementation interventions which comprised external facilitation, to support internal facilitators action learning activities. Evaluation data comprised monthly reporting performance, systems mapping, interviews., Results: System mapping allowed a perspective beyond the characteristics of the NHS Trusts involved (small single site hospitals to large multi-sites hospitals) of mixed clinical duties, scope of practice, reporting session allocation, and equipment used. CAI scores for workplace culture demonstrated x ¯ = 73.7% (SD 6.8; 95%CI 8.49), leadership scored x ¯ = 69.3% (SD 7.3; 95% CI 9.17), and evaluation scored x ¯ = 75.5% (SD 6.9; 95% CI 98.63). WCCAT observations provided themes for facilitation focusing on remote reporting, insourcing backlogs, prioritising worklists to reduce breaching TATs, reporting metrics, and reducing auto reporting. The combined reporting of MSK X-rays by London radiographers during this study achieved x ¯ = 53.7%., Conclusion: This study had an innovative approach using an implementation facilitation framework to improve service delivery. The clinical workplace context in which MSK X-ray reporting by radiographers occurs was key to implementing change. The complexities of sustaining and upscaling MSK X-ray reporting by radiographers to meet the NHS England target of 50% are varied and require local champions to facilitate and drive change at organisational levels. It is recommended that there are dedicated 'resources' to sustain implementations with a community of practice for support. Workplace leadership and stakeholder networks are needed to sustain improved working practices and embrace regular evaluation and monitoring of service delivery performance., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was provided by Canterbury Christ Chruch University (ETH2223-0122). All authors adhered to the guidelines for authorship that are applicable in the "Ethical Responsibilities of Authors" recommendation of the BMC Implementation Science. All authors adhered to Good Clinical Practice (GCP) guidance for people supporting clinical research delivery in NHS England, UK universities and other publicly funded organisations in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: Critical/urgent X-ray findings are not always communicated in an appropriate time frame to ED physicians. The practice of radiographers alerting referrers to clinically significant image findings (verbally, via image flags or written comment) is noted internationally but risk assessment data is unavailable in the literature. A hybrid radiographer comment and alert model was piloted in New South Wales and a risk-benefit assessment conducted for timely and safe communication of abnormal X-ray appearances to ED physicians., Methods: Radiographer comments (n = 1102) were provided to five New South Wales EDs by 69 radiographers for a period of 3-12 months. Site auditors classified comments as true positive (TP), false positive (FP) or indeterminate (ID) with respect to the radiology report. FP comments were investigated with ED referrers and a low-medium-high-risk assessment was provided by two independent reviewers., Results: A total of 42 FP (3.9%; 95% confidence interval [CI] 2.9-5.3) comments were analysed for any adverse outcomes. Risk assessments demonstrated 37 low, 5 low-moderate and no high-risk cases. A total of 282 direct or potential patient benefits were identified (26.4%; 95% CI 23.8-29.1). A total of 42 radiology report discrepancies were incidentally found: (3.9%; 95% CI 2.9-5.3). Audit results demonstrated areas where the radiographer comment could mitigate risk., Conclusion: The provision of radiographer alerts with a written comment for ED was found to be low risk to patients in the pilot study. Radiographers communicating directly with the emergency team when abnormal image appearances are detected can reduce diagnostic error and improve patient safety and health outcomes., (© 2024 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Purpose: No studies have explored the reliability of the Rigo classification system using surface topography (ST), which would allow optimization without radiation exposure. This study aims to measure and compare the intra- and inter-observer reliability (Kappa values) and accuracy of the Rigo system between ST and X-ray for overall types and subtypes., Methods: X-ray and ST images of 31 adolescent idiopathic scoliosis patients were selected. Three investigators were blinded to assess images using the Rigo system, twice for each patient on different weeks, with 372 overall image readings. Afterwards, all investigators agreed upon the correct Rigo scores for finalized classifications., Results: For Rigo types, the average intra-observer Kappa value was slightly better for ST (0.77, p<0.001) than X-ray (0.75, p<0.001). For Rigo subtypes, the average intra-observer Kappa value was again slightly better for ST (0.74, p<0.001) than X-ray (0.65, p<0.001). The inter-observer reliability was expectedly lower than intra-observer, with ST (0.53, p<0.001) comparable to X-ray (0.54, p<0.001) for the type. For subtype inter-observer reliability, ST (0.43, p<0.001) was slightly better than X-ray (0.36, p<0.001). For the type, the overall accuracy of the observers was slightly lower for ST (77.96%) than X-ray (79.57%). For the subtype, the accuracy of observers was slightly higher for ST (70.97%) than X-ray (65.05%)., Conclusion: ST-based Rigo system demonstrates very good intra-rater reproducibility and moderately good inter-rater reproducibility. Surface topography is comparable to X-ray for the Rigo system, and therefore can be considered a reliable alternative in clinical application., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To determine the frequency and clinical consequences of discrepancies in skeletal radiograph interpretation between emergency and radiology doctors in an Australian ED., Methods: We reviewed the records of adult and paediatric patients assessed with skeletal radiography in an ED in Victoria, Australia over 3 months (January to March 2022). Epidemiological data, the interpretation of the radiograph by ED and radiology doctors, and clinical management of the patient were recorded to determine interpretation discrepancies and the consequences of these., Results: There were 2359 unique skeletal radiographs in 1576 patient presentations during the study period. Of these, 140 (6%) had a discrepancy. Where a discrepancy existed, 47% of the ED interpretation reported a fracture and/or dislocation which was not present in the radiology interpretation (false positive), whereas the remaining (53%) were attributed to a missed fracture and/or dislocation (false negative). Thirty-five discrepancies (2%) required a change in patient management and were therefore clinically significant. The most commonly affected body region was the elbow, where 15% of radiographs were discrepant. Pathology was more often missed when multiple abnormalities were present on the same radiograph (odds ratio = 4.2, 95% confidence interval = 2.5-6.8)., Conclusion: The rate of clinically significant discrepancies in the interpretation of skeletal radiographs by emergency medicine doctors is low. This data support using the ED interpretation of radiographs to guide initial management as safe practice., (© 2024 Australasian College for Emergency Medicine.)

Introduction: The Air Force Dental Service is responsible for ensuring that airmen are dentally ready to support military operations worldwide by delivering top-tier dental care. As the military healthcare landscape undergoes significant changes, the Air Force Dental Service has explored innovative approaches to dental care delivery. One consideration involves the potential use of radiographs as the primary tool for assessing service members' dental conditions, specifically focusing on identifying nondeployable conditions and periodontal health., Materials and Methods: Providers who previously participated as examiners in the 2018 Air Force Recruit Oral Health Study were recruited to re-evaluate randomly selected de-identified records, this time making assessments exclusively based on radiographs. Their evaluations included Dental Readiness Classification (DRC) determinations, total caries counts, and Periodontal Screening and Recording (PSR) index scores, providers also rated their confidence in these conclusions using a 5-point Likert scale. The study then computed sensitivity and specificity to assess the diagnostic performance of providers using radiographs only compared to the original study results that use the gold standard of radiographs with a clinical examination., Results: Providers exceled at ruling out most DRC 3 conditions, with specificities surpassing 70%. Positively identifying those with DRC 3, particularly radiographically identifying periodontal conditions posed challenges with computed sensitivity rates as low as 8%. Discrepancies in PSR scores also accentuated limitations in relying solely on radiographs, where provider's radiographically determined PSR scores that matched less than one third of the time. In general, providers had low to very low confidence in their assessments., Conclusions: The study strongly cautions against relying solely on radiographs for determining the dental health of U.S. Air Force personnel. While providers effectively ruled out the absence of certain conditions, the challenge of positively identifying DRC 3 conditions poses significant risks to oral health if such a workflow was utilized. Particularly, the high probability of false negatives would be detrimental to the operational readiness of military personnel. Therefore, results support the continued use of radiographic and clinical examinations for comprehensive dental exams., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Purpose: The periodic quality control of X-ray devices is important for obtaining optical medical images and determining the appropriate X-ray exposure dose. Additionally, the measurement of the X-ray output is constrained by time, technical aspects, and expenses. Therefore, we investigated the usefulness of a simple method for managing X-ray output using an Exposure Index (EI)., Methods: The entire surface of the flat panel detector was X-ray-irradiated every Friday at the time of end-of-work inspection under the condition that the recorded EI was approximately 1000. The EI and exposure dose were measured, and the linearity and accuracy were evaluated., Results: The output gradually decreased from the start of the measurements in Room 1 and stabilized after the output was adjusted. The relationship between exposure dose and EI showed high linearity, with R 2  > 0.99, and the CV of EI was less than 2.41%, indicating high reproducibility., Conclusions: We demonstrated that the results of constancy tests can be easily quantified using EI. The EI method can manage the X-ray output with good reproducibility., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Radiographers in clinical imaging pathways ensure regulatory compliance by justifying X-ray requests, optimising exposure, and communicating urgent findings. In Australia, adherence to Australian regulatory directives is crucial for patient safety, particularly in Emergency Departments (EDs) where immediate radiologist report or guidance may be unavailable. This study explores whether Australian radiographers working within regulatory compliance of justification, optimisation and Preliminary Image Evaluation (PIE) in the ED contribute to improving patient safety?, Methods: In a retrospective blinded single-phase study, 28 radiographers reviewed 50 cases of single extremity trauma in the ED Fast-Track (FT) pathway. Data analysis assessed compliance with regulatory directives, evaluating justification, optimisation, and accuracy of Preliminary Image Evaluations (PIE) against established standards., Results: Justification: Radiographers found 67.8 % (n = 881) of X-ray requests compliant and 32.2 % (n = 419) non-compliant. Optimisation: Participants optimised referrals by correcting anatomical selection (52.0 %, n = 676), adjusting the number of images (11.6 %, n = 151), or both (17.5 %, n = 227). PIE: Radiographer PIE demonstrated a mean sensitivity of 94.7 % (CI: 92.9 %-96.6 %), specificity of 89.6 % (CI: 87.0 %-92.2 %), and accuracy of 92.7 % (CI: 91.6 %-93.8 %). The average Positive Predictive Value (PPV) was 93.2 % (CI: 92.0-94.9 %), the Negative Predictive Value (NPV) was 91.9 % (CI: 90.2-95.0 %), and Cohen's Kappa inter-rater reliability median was K = 0.85, with an average result of K = 0.85 (range: K = 0.74 to K = 0.96)., Conclusion: In this study, radiographer compliance with regulatory standards for justification, optimisation, and PIE is high but not fully consistent. When radiographers adhere to regulations, there is potential to improve patient safety. Collaborative compliance between radiologists, referrers, and radiographers within the ED FT pathway could further improve patient safety outcomes. Additional research, including prospective studies, is necessary to further evaluate radiographer compliance in the ED FT pathway., Implications for Practice: Radiographers are professionally obligated to follow Australian regulatory directives for safe medical radiation practice, guided by imaging protocols. Timely and accurate PIE by radiographers can enhance patient safety in ED., Competing Interests: Conflict of interest statement All authors declare that they have no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The preparation of reports and calculation of dose reference levels (DRLs) for general x-ray radiography are valuable tools for determining appropriate radiation dosage. However, the systematic collection of dose-area product (DAP) dose data can be challenging, and calculating entrance surface air kerma (ESAK)values requires precision and careful calculations., Objective: The aim of this study was to design and implement a website for the collection of DAP values, calculation of ESAK values, and reporting of DRLs from general diagnostic radiographs. Additionally, the study evaluated the quality and satisfaction of radiological technologists using the website., Methods: Website design considerations included navigation, database management, and the development of an interactive web application for displaying and validating calculations. Subsequently, the website was made available to 16 volunteers for evaluation of its effectiveness and user satisfaction., Results: The developed website functioned properly and was capable of recording DAP data, calculating ESAK values, and generating reports on DRL values. Verification of the ESAK and DRL calculations by four experts confirmed their accuracy. The content evaluation yielded a mean score of 4.71 ± 0.49 for content, 4.59 ± 0.65 for usability, 4.55 ± 0.59 for website format, and 4.61 ± 0.60 for overall satisfaction., Conclusion: A website designed for the collection and reporting of DRLs in general diagnostic radiography offered practical application potential. Its functionalities could enhance the work efficiency of radiological technologists and contribute to improved radiation optimization and protection., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: This study aims to provide an overview of different deep learning algorithms (DLAs), identify the limitations, and summarize potential solutions to improve the performance of DLAs., Methods: We reviewed eligible studies on DLAs for automated Cobb angle estimation on X-rays and conducted a meta-analysis. A systematic literature search was conducted in six databases up until September 2023. Our meta-analysis included an evaluation of reported circular mean absolute error (CMAE) from the studies, as well as a subgroup analysis of implementation strategies. Risk of bias was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). This study was registered in PROSPERO prior to initiation (CRD42023403057)., Results: We identified 120 articles from our systematic search (n = 3022), eventually including 50 studies in the systematic review and 17 studies in the meta-analysis. The overall estimate for CMAE was 2.99 (95% CI 2.61-3.38), with high heterogeneity (94%, p < 0.01). Segmentation-based methods showed greater accuracy (p < 0.01), with a CMAE of 2.40 (95% CI 1.85-2.95), compared to landmark-based methods, which had a CMAE of 3.31 (95% CI 2.89-3.72)., Conclusions: According to our limited meta-analysis results, DLAs have shown relatively high accuracy for automated Cobb angle measurement. In terms of CMAE, segmentation-based methods may perform better than landmark-based methods. We also summarized potential ways to improve model design in future studies. It is important to follow quality guidelines when reporting on DLAs., Competing Interests: Declarations. Conflict of interest: There is no conflict of interest in this study. Ethical approval: Given that this study is a systematic review and meta-analysis, it does not necessitate ethical approval., (© 2024. The Author(s).)

Introduction: Despite a demonstrated high accuracy and reported successful implementations, radiographer preliminary image evaluation (PIE) has been slow and infrequent in its rollout across Australia. A key barrier reported to hamper radiographer PIE service implementation is lack of adequate time to review radiographs and provide an accurate interpretation. This study sought to conduct a correlational analysis between radiographer imaging workload and PIE service accuracy., Methods: A total of 45,373 exams and 1152 PIE comments evenly distributed each month from January 1, 2022, to December 31, 2022, were reviewed. PIE comments were assessed for consistency with the radiologist's report. The imaging workload (average exams completed per hour) was separated into three, eight-hour 'shifts' based on time of imaging. Correlational analysis was performed using linear regression models and assessed for normality using the Shapiro-Wilks test., Results: The study reported no significant linear association between increasing average workload and reduced service accuracy (P = 0.136). It was however noted that when the average workload increased beyond 7 exams/hour, average service accuracy for PIE was always below 85%., Conclusion: This study has demonstrated that, although perceived, there is no statistically significant correlation between x-ray imaging workload and radiographer PIE service accuracy. Consideration of this correlation to be a significant barrier to participation in such a service was not reported at this site., (© 2024 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

When a low-energy trauma induces an acute vertebral fracture (VF) with clinical symptoms, a definitive diagnosis of osteoporotic vertebral fracture (OVF) can be made. Beyond that, a "gold" radiographic standard to distinguish osteoporotic from non-osteoporotic VFs does not exist. Fracture-shaped vertebral deformity (FSVD) is defined as a deformity radiographically indistinguishable from vertebral fracture according to the best of the reading radiologist's knowledge. FSVD is not uncommon among young populations with normal bone strength. FSVD among an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely to be associated with compromised bone strength. In more severe grade deformities or when a vertebra is collapsed, OVF diagnosis can be made with a relatively high degree of certainty by experienced readers. In "milder" cases, OVF is often diagnosed based on a high probability rather than an absolute diagnosis. After excluding known mimickers, singular vertebral wedging in older women is statistically most likely an OLVF. For older women, three non-adjacent minimal grade OLVF (< 20% height loss), one minimal grade OLVF and one mild OLVF (20-25% height loss), or one OLVF with ≥ 25% height loss, meet the diagnosis of osteoporosis. For older men, a single OLVF with < 40% height loss may be insufficient to suggest the subject is osteoporotic. Common OLVF differential diagnoses include X-ray projection artifacts and scoliosis, acquired and developmental short vertebrae, osteoarthritic wedging, oncological deformities, deformity due to high-energy trauma VF, lateral hyperosteogeny of a vertebral body, Cupid's bow, and expansive endplate, among others., (© 2024. The Author(s).)

Introduction: Diagnostic errors in the emergency departments can have major implications on patient outcomes. Preliminary Image Evaluation (PIE) is a brief comment written by a radiographer describing an acute or traumatic pathology on a radiograph and can be used to complement referrer's image interpretation in the absence of the radiologist report. Currently, no studies exist that focus their analysis on false-positive (FP) errors in PIE. The purpose of this study was to investigate the regions of the body that cause the most FP errors and recognise other areas in image interpretation that may need additional attention., Methods: A longitudinal retrospective clinical audit was conducted to determine the accuracy of radiographer PIE's over 5 years from January 2016 to December 2020. PIE's were compared to the radiologist report to assess for diagnostic accuracy. FP and unsure errors were further categorised by anatomical region and age., Results: Over this period, a sample size of 11,090 PIE audits were included in the study demonstrating an overall PIE accuracy of 87.7%. Foot, ankle and chest regions caused the most FP errors, while ankle, shoulder and elbow caused the most unsure cases. 76% of the unsure cases were negative for any pathology when compared to the radiologist report. The paediatric population accounted for 21.3% of FP cases and 33.6% of unsure cases., Conclusion: Findings in this study should be used to tailor education specific to radiographer image interpretation. Improving radiography image interpretation skills can assist in improving referrer diagnostic accuracy, thus improving patient outcomes., (© 2024 The Author(s). Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Introduction: Preliminary image evaluation (PIE) is a system where radiographers alert emergency department referrers to the presence or absence of abnormalities on acute extremity X-ray examinations. PIE and similar systems have been utilised in the United Kingdom (UK) and Australia due to a shortage of radiologists to provide a timely report. As New Zealand (NZ) faces a similar shortage, PIE should be considered to address the negative impact this has on patients. The aim of this study was to determine the effect of regular feedback and education on radiographers' performance when detecting and describing acute abnormalities on extremity X-ray examinations in ED., Methods: A prospective longitudinal study design was utilised for this study. The sensitivity, specificity, accuracy, and accuracy of PIEs performed by seven radiographers at a public provincial district in NZ were assessed over a 6-month period, with the participants provided monthly results along with regular e-mailed feedback on common errors., Results: The mean for sensitivity, specificity, and accuracy calculated with a 95% confidence interval over the 6-month period were 92.8% (89.9, 95.8), 94.9 (93.1, 96.8), and 94.2 (91.9, 96.5), respectively. When the month-to-month results were analysed, the results demonstrated an improvement in participants' sensitivity, specificity, and accuracy over the 6-month period., Conclusion: The results of this study demonstrated that radiographers who participated in the study can perform PIE to a high standard that is comparable with the findings from international studies and demonstrated an improvement over 6 months. Therefore, PIE may be useful in NZ to aid ED clinicians in their clinical decisions when a radiology report is unavailable., (© 2024 The Author(s). Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Background: In emergency presentations, it is not uncommon for patients to present with imaging requests of multiple body regions to detect concurrent injury. While current literature explores diagnostic efficacy of adjacent imaging for forearm fractures, there is limited research on its effectiveness across all extremities. This paper explores the diagnostic yield of X-ray adjacent imaging of the upper and lower limb in paediatric patients., Methods: A retrospective audit was performed using information available on radiology request forms from paediatric patients (age <18 years) that had multiple X-rays of adjacent body regions over six months at two hospitals. The main or first X-ray was referred to as initial imaging, while all subsequent X-rays of adjacent regions was considered secondary imaging. Clinical history and radiologists' findings were collected, categorised, and analysed using Chi square., Results: There were 661 X-rays performed across 277 patients. Initial imaging was significantly more likely to detect injuries or abnormalities (35 %) than X-rays of adjacent regions (1.6 %), with 94 % of all abnormalities detected on initial imaging overall (χ2(3) = 241.247, p < 0.001). X-ray request forms with no clinical symptoms were significantly more likely to have no findings detected (χ2(3) = 53.493, p < 0.001)., Conclusion: X-ray imaging of a body region adjacent to an injury has low diagnostic yield, suggesting the need for interventions to reduce unnecessary adjacent X-ray imaging. Clinical history information was often limited and concurrent injuries were low., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Acetabular component anteversion (ACA) markedly impacts the outcome of total hip arthroplasty (THA) and thus is routinely measured on radiographs postoperatively. However, clinical ACA measurement methods are either too complicated or subjective due to three drawbacks: complex calculations, measurement of obscured points, and complex geometric drawings. This study aimed to develop a precise and convenient novel method of measuring ACA on routine radiographs without the three drawbacks and to verify its accuracy and reliability by comparing it against existing methods., Methods: A novel geometric principle to measure ACA was developed. Accordingly, a protractor was designed to measure radiographic anteversion (RA) on anteroposterior (AP) hip radiographs. Three researchers measured RA twice, using the protractor, McLaren's, and Pradhan's method on 26 computer-simulated radiographs with pre-set RAs and 20 actual radiographs. Accuracy was assessed by errors on simulated radiographs, and reliability was assessed by results of measurements on simulated and actual radiographs., Results: The absolute error of the novel method (1.01° ± 1.06°) was lower than McLaren's method (1.34° ± 1.16°) (p < 0.05) and not significantly different from Pradhan's method (1.10° ± 1.02°) (p = 0.392). The protractor's intra-rater and inter-rater reliability were good-to-excellent or excellent and higher or equivalent to the two other methods., Conclusions: The novel method avoids the three major drawbacks of conventional methods. Its accuracy is significantly higher than McLaren's method and comparable to Pradhan's. The novel method has higher or non-inferior accuracy and reliability than McLaren's and Pradhan's methods., Competing Interests: Declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Ethics Committee of Nanfang Hospital of Southern Medical University (approval letter number: NFEC-2023-323). Patient consent was waived by the Medical Ethics Committee of Nanfang Hospital of Southern Medical University due to the research involves no risk to the subjects. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Prompt identification of fracture healing is crucial for medical decision-making and clinical research. This study aims to assess the effectiveness of the Radiographic Union Score for Hip (RUSH) in subtrochanteric fractures and determine the optimal scoring threshold for fracture healing., Methods: We obtained 94 sets of X-ray films from the postoperative follow-up of 35 patients who underwent intramedullary nail fixation for subtrochanteric fractures. Six orthopedic trauma surgeons evaluated the imaging data and determined fracture healing based on subjective judgment. They then scored the X-ray images using the RUSH form. After four weeks, the same observers re-evaluated 47 randomly selected sets of radiographs. Subsequently, the observers and study designer conducted a consensus meeting where they agreed on whether the fractures had healed. We used Fleiss kappa to evaluate agreement among observers based on subjective impressions, and the intraclass correlation coefficient assessed RUSH score consistency. Regression analysis examined the relationship between scores and fracture healing consensus using a receiver operator characteristic (ROC) curve., Results: Based on overall impressions, the agreement level among orthopedic trauma surgeons for determining the healing status of subtrochanteric fractures was moderate (Kappa = 0.564, 95% CI: 0.511-0.616). However, utilizing the RUSH scoring system can improve the consistency to a substantial level of agreement (ICC = 0.748, 95% CI: 0.663-0.817). Regarding intraobserver reliability, there were significant differences among orthopedic trauma surgeons in judging fracture healing based on overall impressions. However, using the RUSH scoring form, the attending group achieved better intraobserver consistency than the resident group. Regression analysis and ROC curve analysis revealed a strong correlation between the RUSH total score, cortical bone score, cancellous bone score, and consensus on fracture healing. The AUC values are 0.769 (95% CI: 0.670-0.868), 0.779 (95% CI: 0.681-0.876), and 0.771 (95% CI: 0.674-0.867), respectively., Conclusions: Our study highlights the effectiveness of the RUSH scoring system in enhancing interobserver agreement and intraobserver consistency when evaluating subtrochanteric fracture healing in orthopedic trauma surgeons. We propose setting 21 points as the threshold for the simplified RUSH scoring system to determine fracture healing. This system includes only eight items related to cortical bone, with a total score of 24 points., (© 2024. The Author(s).)

Background: Up to now, there is no convincing evidence, that surgical treatment of deltoid ligament injuries, especially in the setting of ankle fractures, does result in improved outcome. One reason could be a missing diagnostic standard. The aim of the current systematic review was to analyze the applied diagnostic strategies for acute deltoid ligament injuries in outcome studies., Methods: MEDLINE, Scopus, Central, and EMBASE were searched through February 2022 for any original studies addressing diagnostics of acute deltoid injuries. The study was conducted per the PRISMA guidelines. The inclusion criteria were formed according to the PICOS criteria. The data assessed were study type, level of evidence, included fractures, time point and method of diagnosing deltoid ligament layers, differentiation between layers and syndesmotic injuries., Results: 31 studies were included in the final analysis. Most studies (n = 28) based their decision to treat the deltoid ligament injury on radiologic findings only, with stressed radiographs (n = 18) being the most common. The radiographs were applied at one or more time points (preoperative, before ORIF, after ORIF, after ORIF and syndesmotic repair). The most frequently assessed parameter was the Medial Clear Space (MCS, n = 27) with cut-off-values considered pathological ranging between MCS > 1 mm and MCS > 6 mm., Conclusion: Comparing the 31 studies shows that a standardized method to diagnose deltoid ligament injuries is missing. Further research is needed to establish evidence-based guidelines on how to diagnose acute deltoid ligament injuries., Trial Registration: Prospero ID: CRD42022307112., Clinical Trial Number: not applicable., (© 2024. The Author(s).)

Radiographic measurements play a crucial role in evaluating the alignment of distal radius fractures (DRFs). Various manual methods have been used to perform the measurements, but they are susceptible to inaccuracies. Recently, computer-aided methods have become available. This review explores the methods commonly used to assess DRFs. The review introduces the different measurement techniques, discusses the sources of measurement errors and measurement reliability, and provides a recommendation for their use. Radiographic measurements used in the evaluation of DRFs are not reliable. Standardizing the measurement techniques is crucial to address this and automated image analysis could help improve accuracy and reliability., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: E.W. has owned stock in Disior Ltd, Helsinki, Finland and sold them in January 2022. N.S. has no conflicts of interest to declare.

Introduction: To reduce the risks involved with ionising radiation exposure, typical values (TVs) and diagnostic reference levels (DRLs) have been established to help keep radiation doses 'as low as reasonably practicable. TVs/DRLs provide standardised radiation dose metrics that can be used for comparative purposes. However, for paediatrics, such values should consider the size of the child instead of their age. This study aimed to establish and compare paediatric TVs for chest, abdomen and pelvis radiography., Methods: Study methods followed processes for establishing paediatric DRLs as outlined by the Health Information and Quality Authority (HIQA). Kerma-area product (KAP) values, excluding rejected images, were retrospectively acquired from the study institution's Picture Archiving and Communications System (PACS). Paediatric patients were categorised into the following weight-based groupings (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg) and stratified based on the examination that was performed (chest, abdomen, and pelvis), and where it was performed (the different X-ray rooms). Anonymised data were inputted into Microsoft Excel for analysis. Median and 3rd quartile KAP values were reported together with graphical illustrations., Results: Data from 407 X-ray examinations were analysed. For the previously identified weight categories (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg), TVs for the chest were 0.10, 0.19, 0.37 and 0.53 dGy.cm 2 , respectively. For the abdomen 0.39, 1.04, 3.51 and 4.05 dGy.cm 2 and for the pelvis 0.43, 0.87, 3.50 and 7.58 dGy.cm 2 . Between X-ray rooms TVs varied against the institutional TVs by -60 to 119 % (chest), -50 to 103 % (abdomen) and -14 and 24 %% (pelvis)., Conclusion: TVs in this study follow established trends with patient weight and examination type and are comparable with published literature. Variations do exist between individual examination rooms and reasons are multifactorial. Given that age and size do not perfectly correlate further work should be undertaken around weight-based TVs/DRLs in the paediatric setting., (Copyright © 2024. Published by Elsevier Inc.)

The management of trauma is a significant part of emergency medicine practice, in a context where the number of sports accidents is rising steadily every year, with a total of 430,000 people affected in Switzerland in 2023 according to the Swiss Accident Prevention Bureau. In addition to the physical examination, radiological assessment is a cornerstone of diagnosis. Radiology of the musculoskeletal system is the most frequently requested paraclinical examination in these situations. The consequences of not recognizing radiological lesions may result in short-term consequences (haemorrhagic or neurological injuries) or long-term consequences (chronic pain, functional impairment). We therefore present examples of "pitfalls in radiology" frequently encountered in our daily clinical practice, and the use of additional exams., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The role of radiographers in healthcare has evolved significantly from operating imaging equipment to being essential in patient care and diagnosis. In Australia, radiographers play a crucial role in image interpretation, identifying and communicating significant findings to enhance patient outcomes. Preliminary image evaluation (PIE) allows radiographers to interpret images and ensure significant findings are noted, particularly in urgent situations, complementing diagnoses when radiologist reports are unavailable. Despite their potential, many radiographers lack empowerment, leading to delays and adverse patient outcomes. This underutilisation stems from a lack of support and systemic barriers. Radiographers, with their extensive expertise in imaging, are vital for ensuring patient safety and care quality. Policy changes are needed to integrate PIE into standard workflows, allowing radiographers to fully utilise their skills. Recognising and leveraging their expertise will enhance patient care, foster collaboration, and ensure radiographers contribute fully to the healthcare team, ultimately improving patient safety and care quality.

Objective: The purpose of this study was to assess the influence of prior imaging review on recommendations for additional diagnostic testing in an academic chiropractic radiology practice. A secondary aim was to explore the influence of prior imaging review on radiographic interpretation., Methods: We retrospectively reviewed radiology reports generated from July 18, 2022, to July 18, 2023, from the Palmer College of Chiropractic main campus (Davenport, Iowa) clinic system. Imaging interpretation included an automated search for prior images in an internal picture archival and communication system (PACS). Images from regional health system databases were available and sought by radiologists when (1) unclear radiologic findings had potential clinical implications or (2) prior imaging could clarify potential problems detected in a clinical history. Data were abstracted to a secure adaptive electronic questionnaire and analyzed descriptively., Results: We reviewed 1712 radiographic and 165 musculoskeletal diagnostic ultrasound reports for 1552 unique individuals (811 [52.3%] females and 741 [47.7%] males) with a mean age of 42.1 years (range, 2-93 years). Prior imaging was described in 417 (22.2%) reports; 246 (58.9%) indicated images from internal PACS, 192 (46.0%) indicated images from external PACS, and 21 noted both internal and external PACS. Prior imaging findings were credited with answering a clinical question in 98 (23.5%), and a radiographic question in 228 (54.7%) of 417 reports. The process negated the need for follow-up diagnostic testing recommendations in 119 (28.5%) instances, leading to additional imaging recommendations in 19 (4.6%)., Conclusion: Data obtained in this study suggest that comparing current and previous imaging may help reduce unnecessary additional imaging or follow-up diagnostic testing recommendations. Prior imaging review may also facilitate diagnostic confidence and interpretation clarity., (Copyright © 2024. Published by Elsevier Inc.)

Veterinary practitioners and other personnel involved in the examination are exposed to ionizing radiation while performing portable radiographs on horses. An online survey was distributed to all Veterinary Council of Ireland-registered practices where the self-reported practice profile is at least 20% equine work. The survey contained questions relating to radiation safety training, protocols, personal dosimetry and lead protection usage, repeat exposures, sedation, and personnel roles during the examination. The aim of the survey was to document the current radiation safety practices of equine veterinary practitioners during portable radiography. The results showed that although adherence to guidance set out by the Environmental Protection Agency (EPA) is reasonably good, compliance rates can be improved. Personal dosemeter usage and repeat rate reduction could particularly benefit from further improvement. This is of the utmost importance in ensuring that occupational radiation exposure to veterinary practitioners is kept to an absolute minimum during their daily practice., (© The Author(s) 2024. Published by Oxford University Press.)

Introduction: To minimise the risks associated with ionising radiation, it is necessary for all staff involved to employ specific techniques to reduce radiation exposure of the patient. These techniques include using compression during examinations of the pelvic region and lumbar spine, using a gonad shield, and asking women if they are pregnant. However, some staff do not use these techniques consistently. Increasing compliance requires determining why staff are non-compliant. Thus, this study aims to qualitatively investigate why radiographers do not use these techniques., Methods: This qualitative study is based on a cross-sectional electronic survey with open-ended questions. The data were analysed using an inductive qualitative content analysis with quantification of the findings. In total, 111 radiographers from 20 hospitals in Sweden participated., Results: Three categories appear related to barriers that could obstruct the radiographer from using compression, gonad shields and asking about pregnancy: patient characteristics, interaction between the patient and the radiographer and issues related to the situation and examination., Conclusions: The barriers to not using radiation protection measures varied depending on the specific measure. However, the barriers were mainly related to the patient experiencing pain, communication difficulties and cultural reasons. In addition, the lack of adequate and user-friendly equipment was seen as a barrier to applying compression and using gonad shielding., (© 2024 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Introduction: The aim of this study was to clarify the perspective of radiography science as an academic discipline. A discipline can be studied by discovering the collective use of concepts, especially core concepts. We have previously identified the core concepts as clinical practices in radiography, radiographers' profession, safe and high-quality radiation use, and technology in radiography. The relationships between these concepts have not been studied previously. In order to clarify the perspective of radiography science we have investigated further the core concepts, their interrelationships and interdependencies., Methods: Altogether, 53 dissertations meeting the inclusion criteria were selected for a qualitative document analysis. The data were first analysed deductively using an extraction matrix comprising four core concepts developed from previous studies, then relational statements were synthesised, and the statements were analysed semantically., Results: Analysis revealed the bilateral interrelationships between the concepts and their dependencies. All the concepts were used within healthcare. The rationale for radiography science research was the clinical practice of radiography and the improvement of services in a complex environment as a part of patients' pathways. Safe and high-quality radiation use was investigated as a means to deliver optimal services. Technology was studied as being functional or a means to deliver services. The perspective of the discipline was seen as the combination of humanistic interaction with advanced technology, where safety and quality were a necessity., Conclusions: Defining core concepts and their interrelations clarifies the perspective of the discipline and gives radiography researchers a way to argue their viewpoint., (© 2024 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Introduction: Implementation and application of evidence-based practice through legislation, international and national guidelines and local protocols is integral to the successful undertaking of forensic radiographic practice, because of its medico-legal role. This research aims to evaluate those organisational barriers and facilitators to its effective implementation., Methods: This scoping review was undertaken according to the JBI updated guidelines using the PCC mnemonic. A systematic search of 10 databases was undertaken to identify literature addressing the research question relating to this aspect of forensic radiography practice. Handsearching and snowballing were also included to enhance this search strategy. The search focussed on forensic imaging of paediatrics, the living and deceased., Results: Of the 301 papers initially selected, 9 articles were identified as eligible for inclusion, encompassing an international perspective. Through Inductive Content Analysis, 5 conceptual categories were developed: ineffective organisational governance, education translation, system brakes, default practice, and value-based judgement., Conclusion: The results indicate that there are many complex and multifactorial organisational issues impacting upon effective implementation of best practices within paediatric forensic imaging. There is a need to address these issues, before attempting strategies for future implementation. It is essential to recognise that there can be no one-size-fits approach, but rather tailored strategies are required recognising individual needs within the multi-disciplinary scope of forensic radiographic practice., Implications for Practice: Failure to recognise and address the identified issues impacting upon effective implementation, may have significant implications on the processes and individuals involved in the forensic imaging acquisition pathway. Successful addressing of these issues may enable the professionals involved in organisational governance to create a more conducive and receptive environment for best-practice implementation., Competing Interests: Conflict of interest statement The authors listed below certify that they have NO affiliations with or involvement in any organisation or entity with any financial interest, or non-financial interest in the subject matter of materials discussed in this manuscript., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Purpose: To examine whether radiologic technologists' perceptions of imaging appropriateness differed based on their primary imaging modality, work shift, shift length, and primary practice type., Methods: A national, cross-sectional study was conducted in the fourth quarter of 2019 using a simple, randomized sample of American Society of Radiologic Technologists (ASRT) members. Study participants were employed in health care settings in radiography, computed tomography (CT), mammography, or radiology leadership. Seven potential reasons for inappropriate imaging procedures (ie, patient expectations, provide patient with a feeling of being taken seriously, lack of time, expectations from relatives, compensation for insufficient clinical examination, normal findings would reassure the patient, and fear of lawsuits) were evaluated for relationships with their primary imaging modality, work shift, shift length, and primary practice type., Results: Disparities in perceived reasons affecting imaging appropriateness were found. Providing the patient with a feeling of being taken seriously was related to primary practice type ( P = .022). Lack of time was related to primary imaging modality ( P = .005) and primary practice type ( P = .006). Expectations from relatives was related to primary imaging modality ( P = .016) and primary practice type ( P = .027). Compensation for insufficient clinical examination was related to primary imaging modality ( P < .001), shift length ( P = .011), work shift ( P = .002), and primary practice type ( P < .001). Fear of lawsuits was related to primary imaging modality ( P = .001)) and work shift ( P = .002)., Discussion: The study reveals that radiologic technologists' perceptions of patient-centered factors and defensive medicine-related factors differ among imaging modalities, shift types, and practice settings. However, more research is required to determine why radiologic technologists perceive these reasons to be present, investigate whether providers feel similarly, and determine perceptual alignment with evidence-based guidelines., Conclusion: The findings suggest that attention should focus on the appropriateness of CT imaging procedures performed in hospitals during night shifts., (© 2022 American Society of Radiologic Technologists.)

Background: Establishing the etiology of community-acquired pneumonia (CAP) in children at admission is challenging. Most of the admitted children with CAP receive antibiotics. We aimed to build and validate a diagnostic tool combining clinical, analytical and radiographic features to differentiate viral from bacterial CAP, and among bacterial CAP, typical from atypical bacteria., Methods: Design-observational, multi-center, prospective cohort study was conducted in 2 phases. Settings: 24 secondary and tertiary hospitals in Spain. Patients-A total of 495 consecutive hospitalized children between 1 month and 16 years of age with CAP were enrolled. Interventions-A score with 2 sequential steps was built (training set, 70% patients, and validation set 30%). Step 1 differentiates between viral and bacterial CAP and step 2 between typical and atypical bacterial CAP. Optimal cutoff points were selected to maximize specificity setting a high sensitivity (80%). Weights of each variable were calculated with a multivariable logistic regression. Main outcome measures-Viral or bacterial etiology., Results: In total, 262 (53%) children (median age: 2 years, 52.3% male) had an etiologic diagnosis. In step 1, bacterial CAPs were classified with a sensitivity = 97%, a specificity = 48%, and a ROC's area under the curve = 0.81. If a patient with CAP was classified as bacterial, he/she was assessed with step 2. Typical bacteria were classified with a sensitivity = 100%, a specificity = 64% and area under the curve = 0.90. We implemented the score into a mobile app named Pneumonia Etiology Predictor, freely available at usual app stores, that provides the probability of each etiology., Conclusions: This 2-steps tool can facilitate the physician's decision to prescribe antibiotics without compromising patient safety., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Accessibility to chest radiography remains a major challenge in high burden and low-income countries. The World Health Organization (WHO) guidelines acknowledge that for child contacts under 5 years, a negative symptom-based screening is sufficient to exclude active tuberculosis (TB), but in child contacts older than 5 years, a chest radiograph should be considered. We performed a systematic review and meta-analysis to assess the performance of symptom-based screening compared with chest radiography in household contacts under 15 years in low-income and middle-income countries., Methods: Screening articles published prior 1 October 2020 and data extraction were performed by 2 independent reviewers. The primary outcome was the concordance between symptom screening and chest radiography using the prevalence adjusted bias adjusted kappa coefficient (PABAK) and the proportion of asymptomatic children with negative chest radiography. The analysis was stratified by age group., Results: Of 639 identified articles, 10 were included. PABAK varied between 0.09 and 0.97 and between 0.22 and 0.98, in children less than 5 years and 5-14 years, respectively. The pooled proportion of children with both non-TB suggestive symptoms and chest radiography findings was 98.7% (96.9-99.8) in children less than 5 years and 98.1% (93.8-100) in children of age 5-14 years., Conclusions: Despite low concordance between symptom-based screening and chest radiography, most children without TB suggestive symptoms did not have chest radiography findings suggestive of TB. These results suggest that a negative symptom screening is sufficient to rule out active TB, supporting the WHO recommendation to use symptom-based screening alone when chest radiography is not available., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: In 2-dimensional lateral cephalometric radiographs, patients with severe obstructive sleep apnea (OSA) exhibit a more crowded oropharynx in comparison with non-OSA. We tested the hypothesis that machine learning, an application of artificial intelligence (AI), could be used to detect patients with severe OSA based on 2-dimensional images., Methods: A deep convolutional neural network was developed (n = 1258; 90%) and tested (n = 131; 10%) using data from 1389 (100%) lateral cephalometric radiographs obtained from individuals diagnosed with severe OSA (n = 867; apnea hypopnea index > 30 events/h sleep) or non-OSA (n = 522; apnea hypopnea index < 5 events/h sleep) at a single center for sleep disorders. Three kinds of data sets were prepared by changing the area of interest using a single image: the original image without any modification (full image), an image containing a facial profile, upper airway, and craniofacial soft/hard tissues (main region), and an image containing part of the occipital region (head only). A radiologist also performed a conventional manual cephalometric analysis of the full image for comparison., Results: The sensitivity/specificity was 0.87/0.82 for full image, 0.88/0.75 for main region, 0.71/0.63 for head only, and 0.54/0.80 for the manual analysis. The area under the receiver-operating characteristic curve was the highest for main region 0.92, for full image 0.89, for head only 0.70, and for manual cephalometric analysis 0.75., Conclusions: A deep convolutional neural network identified individuals with severe OSA with high accuracy. Future research on this concept using AI and images can be further encouraged when discussing triage of OSA., (© 2021. The Author(s).)

The aims of this study were to (1) assess reliability of leg length discrepancy (LLD) measurements at different anatomical landmarks, (2) longitudinally investigate LLD in patients within the first year following total hip arthroplasty (THA) and to (3) correlate changes in LLD with functional outcome. Ninety-nine patients with short stem THA (53.3% males, mean age: 61.0 ± 8.1 years) were prospectively included. Upright pelvic anteroposterior (a.p.) radiographs taken at 6 timepoints (preoperatively, discharge, 6, 12, 24, 52 weeks postoperatively) were used to assess LLD at 5 anatomical landmarks (iliac crest, upper sacroiliac joint, lower sacroiliac joint, tear drop figure, greater trochanter). WOMAC and Harris Hip Score (HHS) were obtained preoperatively and at 6 and 52 weeks. LLD measures significantly increased in the initial phase following THA, from discharge to 6 weeks postoperatively and remained constant thereafter. Documentation of LLDs is dependent on measurement site: LLDs varied significantly between trochanter and iliac crest to tear drop figure (p < 0.001). Functional assessments did not correlate with the occurrence of LLDs [WOMAC (p = 0.252); HHS (p = 0.798)]. Radiographic assessment of LLD following THA may not be performed early postoperatively, as measurements appear to inaccurately reflect actual LLDs at this time, potentially due incomplete leg extension and/or inhibited weight-bearing., (© 2021. The Author(s).)

Objectives: Children are often transferred to a Pediatric Emergency Department (PED) for definitive care after completion of diagnostic imaging. There is a paucity of data on the concordance rates of interpretation of imaging studies between referral and PED. Our objective is to describe the rates and clinical impact of discordant interpretation of X-rays and CT in children transferred to a PED., Methods: This was a retrospective cohort study of patients over a 12-month period from 12/1/2017-11/30/2018 with X-ray (XR) and CT performed prior to transfer to our PED. We compared referral radiology interpretations to those of pediatric radiologists to determine concordance. Encounters with discordant imaging interpretations were further evaluated for clinical impact (none, minor or major) based on need for additional laboratory workup, consultation, and changes in management and disposition., Results: We analyzed 899 patient encounters. There were high rates of concordance in both XR and CT interpretation (668/743; 89.9%, 95% CI 0.87-0.91 and 205/235; 87.2%, 95% CI 0.82-0.91, respectively). XR discordance resulted in minor clinical impact in 34 patients (45%, 95% CI 0.35-0.57) and a major clinical impact in 28 patients (37%, 95% CI 0.27-0.49). CT discordance resulted in minor clinical impact in 10 patients (33%, 95% CI 0.19-0.51) of patients and major clinical impact in 15 patients (50%, 95% CI 0.33-0.67). The most common discordances with major clinical impact were related to pneumonia on XR chest and appendicitis or inflammatory bowel disease on CT abdomen., Conclusions: In patients transferred to the PED, concordance of XR and CT interpretations was high. A majority of discordant interpretations led to clinical impact meaningful to the patient and emergency medicine (EM) physician. Referring EM physicians might consider the benefit of pediatric radiology consultation upon transfer, especially for imaging diagnoses related to pneumonia, appendicitis, or inflammatory bowel disease., Competing Interests: Declaration of Competing Interest Jason Miller reports no conflict of interest. Ciara Ivanics reports no conflict of interest. Kristina Zalewski reports no conflict of interest. Swati Mody reports no conflict of interest. Nirupama Kannikeswaran reports no conflict of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To investigate the accuracy of X-ray and magnetic resonance imaging (MRI) measurements in evaluating the displacement of humeral lateral condyle fracture (HLCF) in different positions of the forearm based on human cadaveric HLCF models., Methods: Three human cadaveric elbow HLCF fracture models were successfully established. The wrist joint was fixed, and the forearm was rotated forward along the mid-axis. The maximum distance between the two segments of the lateral fracture gap was defined as LFS (lateral fracture space) distance, and the maximum distance between the two segments of the fracture gap at the anterior and posterior margins of the fracture model was defined as PFS (posterior fracture space). The LFS and PFS distances of the human cadaveric elbow HLCF fracture models were measured during forearm rotation at 0º, 45º, 90º, and 135º rotation using a Capture Motion System (CMS), positive and lateral elbow X-ray, coronal and sagittal MRI scans, respectively, and the CMS measurements were considered as the true fracture gap distances. The values obtained by CMS, X-ray, and MRI measurements for both LPS and PFS distances in the HLCF fracture model at each position during rotation were recorded. The LFS and PFS distances were measured by two independent orthopaedic and joint imaging physicians. The data were measured three times by each physician, and the final values were the average of the two measurements. The outcomes were determined by whether a statistical difference exists in the LFS and PFS among the CMS, X-ray, and MRI groups., Results: The interobserver agreement tests between the two observers showed good agreement in the measurements. A multiple sample ANOVA showed statistical differences in the LFS distances of HLCF measured at 0º, 45º, 90º, and 135º rotated by three radiographic measurements (P < 0.05). The LFS distances obtained by MRI and CMS measurements were greater than those obtained by X-ray measurement in all positions using the LSD test (P < 0.05), and no statistical difference was found between the CMS and MRI methods in each position (P > 0.05). The same results were observed in terms of PFS values obtained by CMS, X-ray, and MRI measurements at 0º, 45º, 90º, and 135º pronation. It was statistically different among the three groups as shown by multiple sample ANOVA (P < 0.05). The CMS and MRI measurements were greater than the X-ray measurements (P < 0.05), while no statistical difference was observed between the CMS and MRI measurements (P > 0.05)., Conclusion: X-rays often underestimate the degree of displacement of HLCF fractures; MRI measurements are closer to the true values compared with X-ray., (© 2021 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Objectives: This study is an evaluation of the emergency department (ED) satisfaction with the current radiologic reporting system used at a major Northeastern academic medical center. The radiology reports are the main form of communication and usually the final product of any radiological investigation delivered to clinicians. The aim of this study was to improve current radiology reporting practices and to better tailor reports to match the needs and expectations of ED clinicians., Methods: A 9-question online survey was sent to ED residents, fellows, faculty, and nurse practitioners/advanced practice providers at a major Northeastern academic medical center in the United States. For the open-ended section, coding and emergent theme categorization was conducted for quantification of responses. The survey was designed to evaluate the attitudes toward the structure, style, form, and wording used in reports., Results: The response rate was 48.6% (68/140). The ED respondents were generally satisfied with radiology reports, their language, vocabulary, and clarity. They preferred the impression section to be before the findings in simple examinations and to stratify the reports according to emergency status for complex examinations. They did not like extended differential, hedge terms, and delayed reporting. Additionally, ED respondents recommended focused, fast reporting with considerable changes toward a more standardized report., Conclusions: This evaluation delivered a list of actionable recommendations. The top recommendation is to standardize reporting structure, style, and lexicon, in addition to being focused, timely, and brief.

Study Design: Retrospective observational study., Objective: To assess the accuracy and reliability of standing lateral lumbar radiographs for measurements of spinopelvic parameters, compared with whole-spine EOS® images., Summary of Background Data: Lateral lumbar radiographs are commonly used for measurements of spinopelvic parameters. However, variable magnifications by fan-beam x-ray projection at margins may cause measurement errors., Methods: Fifty consecutive patients with standing lateral lumbar radiographs and whole-spine EOS® images were retrospectively reviewed from March to July in 2019. Two orthopedic surgeons (observers) independently measured the spinopelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) on the computers. These spinopelvic parameters of each patient were measured twice on both lateral lumbar radiograph and EOS® image by two observers with the usage of Surgimap software. The measurement difference and agreement of each parameter value between lateral lumbar radiographs and EOS® images were analyzed by paired t test and the interclass correlation coefficient (ICC) respectively. Intra- and inter-observer's reliabilities of both imaging methods were assessed by ICC., Results: The measurement difference of each spinopelvic parameter on EOS® images and lateral lumbar radiographs was less than 1° on average. Only the measurement difference of PI value revealed statistically significant (P = 0.020) with 0.9° discrepancy (95% confidential interval: 0.2-1.6), which indicated no clinical significance. The ICC values of lateral lumbar radiographs and EOS® images were more than 0.870 (range, 0.872-0.976), thus showed good to excellent measurement agreement between both imaging methods. All the ICC values for evaluating intra- and inter-observer reliability were greater than 0.960 (range, 0.963-0.993), indicating excellent reliability for observer's measurements., Conclusion: Measurements of spinopelvic parameters (PI, PT, SS, and LL) on standing lateral lumbar radiographs are accurate and reliable, which are comparable to whole-spine EOS® images.Level of Evidence: 3., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death., Aims: To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU., Methods: The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits)., Results: Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, "OK to use" order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site., Linking Action to Evidence: Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice., (© 2021 Sigma Theta Tau International.)

This retrospective cohort study describes adult cervical deformity(ACD) patients with Ames-ACD classification at baseline(BL) and 1-year post-operatively and assesses the relationship of improvement in Ames modifiers with clinical outcomes. Patients ≥ 18yrs with BL and post-op(1-year) radiographs were included. Patients were categorized with Ames classification by primary deformity descriptors (C = cervical; CT = cervicothoracic junction; T = thoracic; S = coronal) and alignment/myelopathy modifiers(C2-C7 Sagittal Vertical Axis[cSVA], T1 Slope-Cervical Lordosis[TS-CL], Horizontal Gaze[Horiz], mJOA). Univariate analysis evaluated demographics, clinical intervention, and Ames deformity descriptor. Patients were evaluated for radiographic improvement by Ames classification and reaching Minimal Clinically Important Differences(MCID) for mJOA, Neck Disability Index(NDI), and EuroQuol-5D(EQ5D). A total of 73 patients were categorized: C = 41(56.2%), CT = 18(24.7%), T = 9(12.3%), S = 5(6.8%). By Ames modifier 1-year improvement, 13(17.8%) improved in mJOA, 26(35.6%) in cSVA grade, 19(26.0%) in Horiz, and 15(20.5%) in TS-CL. The overall proportion of patients without severe Ames modifier grades at 1-year was as follows: 100% cSVA, 27.4% TS-CL, 67.1% Horiz, 69.9% mJOA. 1-year post-operatively, severe myelopathy(mJOA = 3) prevalence differed between Ames-ACD descriptors (C = 26.3%, CT = 15.4%, T = 0.0%, S = 0.0%, p = 0.033). Improvement in mJOA modifier correlated with reaching 1-year NDI MCID in the overall cohort (r = 0.354,p = 0.002). For C descriptors, cSVA improvement correlated with reaching 1-year NDI MCID (r = 0.387,p = 0.016). Improvement in more than one radiographic Ames modifier correlated with reaching 1-year mJOA MCID (r = 0.344,p = 0.003) and with reaching more than one MCID for mJOA, NDI, and EQ-5D (r = 0.272,p = 0.020). In conclusion, improvements in radiographic Ames modifier grades correlated with improvement in 1-year postoperative clinical outcomes. Although limited in scope, this analysis suggests the Ames-ACD classification may describe cervical deformity patients' alignment and outcomes at 1-year., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier Ltd.)

Background: The Commission of the European Communities (CEC) has published: European Guidelines on Quality Criteria for Diagnostic Radiographic Images. These guidelines are considered a gold standard, recommended for use in quality assurance protocols. The objectives of this study: 1) Propose a graded classification format for Danish chiropractic clinics according to the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. 2) Propose a reporting principle for quality of radiographic images. 3) Document variation in radiation exposure among clinics., Methods: This is a cross-sectional study of image quality based on random sampling from 148 chiropractic clinics. Clinics were included if using: 1) Digital radiography and 2) The chiropractic picture and archiving system (KirPACS) at the Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB) in Denmark. A sample of 296 lumbar spine series were randomly collected from KirPACS (January 2018). Two independent observers reviewed 50 lumbar spine series twice with a 4-week interval, testing intra- and inter-observer reproducibility. The same observers then reviewed the remaining 246 radiographic studies. All studies were evaluated using the CEC Quality Criteria. Patient radiation dose values were retrieved from KirPACS (First quarter of 2020)., Results: A reporting and classification principle of diagnostic image quality was used in 148 chiropractic clinics. Compliance with the 22 CEC Quality Criteria had proportions ranging from 0.72-0.96 for 18 criteria, while 4 criteria specifying detail and definition ranged between 0.20-0.66. The proposed rating system (A to E) revealed: 18 A clinics, 28 B clinics, 32 C clinics, 25 D clinics and 45 E clinics (A = highest quality; E = lowest quality). The patient radiation reference dose in Denmark is 7 mGy for the AP/PA lumbar spine. Very few clinics exceed the reference dose value, approximately 50% of clinics were below 5 mGy., Conclusion: A reporting principle is proposed for a graded classification format based on the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. The Quality Criteria are for the most part met satisfactorily in 148 Danish chiropractic clinics, but important image details are compromised, in most cases, because of low patient radiation doses. The results of a patient radiation dose survey enabled documentation of variation in radiation exposure among chiropractic clinics.

Introduction: Imaging is essential for the initial diagnosis and monitoring of the novel coronavirus, which emerged in Wuhan, China. This study aims to assess the insight of radiographers on how the COVID-19 pandemic has affected their work routine and if protective measures are applied., Method: A prospective observational study was conducted among radiographers registered in the Cyprus Society of Registered Radiologic Technologists & Radiation Therapy Technologists. A questionnaire composed of 28 multiple choice questions was utilised, and the data analysis was performed using SPSS software with the statistical significance assumed as p-value < 0.05., Results: Out of 350 registered radiographers, 101 responses were received. The results showed that there are statistically significant differences regarding the working hours, the feeling of stress, the work effectiveness, the average examination time, the presence of a protocol used among the different workplaces of the participants; a private radiology centre, a private hospital or a public hospital, with a p-value 0.0022, 0.015, 0.027, 0.001, 0.0001 respectively. Also, statistically significant differences were observed in the decontamination methods used for equipment (p-value 0.007), for air (p-value 0.04) and when decontamination takes place (p-value 0.00032) among the different workplaces of the participants. Nonetheless, the majority of radiographers believe that their workplace is sufficiently provided with PPE, cleaning supplies, equipment, and with cleaning personnel and are optimistic regarding the adequacy of these provisions in the next three months., Conclusion: This study showed that in the Republic of Cyprus, there are protocols regarding protective measures against COVID-19, and the radiographers are adequately trained on how to face an infectious disease outbreak. However, work is needed in order to develop protocols that reassure the safety of patients and medical personnel while managing the excess workload effectively., Implications for Practice: This study indicates the importance of applying protective measures and protocols in the radiology departments in order to minimise the spread of the virus., Competing Interests: Conflict of interest statement The authors will like to state that they have no conflict of interest., (Copyright © 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Skeletal survey (SS) continues to be used in the community to detect bone disease in patients with multiple myeloma (MM). While the false-negative rate is high, the specificity of SS is less well characterised. Here, we compare the diagnostic accuracy of SS compared to 18 F-FDG-PET/CT (positron emission tomography/computed tomography) in 79 patients referred to our tertiary centre with a diagnosis of smouldering MM. SS had a specificity of 83·1% (95% confidence interval: 72·0-90·5%). This study reinforces the importance of using more specific imaging techniques to avoid inaccurate diagnosis that could lead to the risks associated with unnecessary therapy in patients with smouldering MM., (Published 2020. This article is a U.S. Government work and is in the public domain in the USA.)

Musculoskeletal symptoms may be due to noninflammatory causes, including genetic disorders. We aimed to examine the final genetic diagnosis in patients who presented with musculoskeletal complaints to the rheumatology department. Patients who presented to the Department of Pediatric Rheumatology and were referred to the pediatric genetic department between January 2015 and May 2019 were evaluated retrospectively. A total of 60 patients, 19 boys (31.66%), with a mean age of 12.46 ± 1.41 years were included in the study. The total consanguinity rate was 25%. The most common (29.5%) cause of referral to the pediatric genetic department was the presence of skeletal anomalies (such as camptodactyly, clinodactyly, and short stature) with accompanying joint findings. Approximately one-third of the patients (n: 19) were diagnosed and followed up by the pediatric genetics department. The diagnoses of patients were as follows: camptodactyly, arthropathy, coxa vara, and pericarditis (CACP) syndrome (n: 3); trichorhinophalangeal syndrome (n: 1); progressive pseudorheumatoid dysplasia (n: 2); LIG4 syndrome (n: 1); H syndrome (n: 1); spondyloenchondrodysplasia (SPENCD) (n: 3); and nonspecific connective tissue disorders (n: 8). In the differential diagnosis of patients who are referred to the Department of Pediatric Rheumatology with complaints of the musculoskeletal system, genetic disorders should also be considered., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)