Virtual fracture clinic reduces patient X-ray volume for common wrist and ankle fractures

Abstract Background Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management, whilst maintaining high levels of patient satisfaction. Aims Our aim was to evaluate whether VFCs reduce the volume of X-rays performed for common fractures of the wrist and ankle. Methods A retrospective cohort review was performed. The pre-VFC group consisted of 168 wrist and 108 ankle referrals from March to September 2019. The VFC group included 75 wrist and 68 ankle referrals, during the period March to September 2020. The total number of X-ray images, carried out within a 3-month period for each fracture was summated, with statistical analysis performed following fracture pattern classification. Findings A statistically significant decrease in mean X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius, − 0.976 (p = 0.00025), and Weber A ankle fractures, − 0.907 (p = 0.000013). A reduction was also observed for more complex fracture patterns such as dorsally displaced distal radius, − 0.701 (p = 0.129) and Weber B ankle fractures, − 0.786 (p = 0.235), though not achieving statistical significance. Conclusions Virtual fracture clinics can reduce X-ray frequency for common stable wrist and ankle fractures, with resultant benefits for both patients and healthcare systems. These benefits may be sustained in patient care beyond the current COVID-19 pandemic.

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Probing cosmic isotropy with a new X-ray galaxy cluster sample through the LX–T scaling relation

Astronomy and Astrophysics ◽

10.1051/0004-6361/201936602 ◽

2020 ◽

Vol 636 ◽

pp. A15 ◽

Cited By ~ 16

Author(s):

K. Migkas ◽

G. Schellenberger ◽

T. H. Reiprich ◽

F. Pacaud ◽

M. E. Ramos-Ceja ◽

...

Keyword(s):

Galaxy Clusters ◽

Statistical Significance ◽

Cosmological Parameters ◽

Galaxy Cluster ◽

Temperature Measurements ◽

Joint Analysis ◽

Scaling Relations ◽

Exact Nature ◽

X Rays ◽

X Ray

The isotropy of the late Universe and consequently of the X-ray galaxy cluster scaling relations is an assumption greatly used in astronomy. However, within the last decade, many studies have reported deviations from isotropy when using various cosmological probes; a definitive conclusion has yet to be made. New, effective and independent methods to robustly test the cosmic isotropy are of crucial importance. In this work, we use such a method. Specifically, we investigate the directional behavior of the X-ray luminosity-temperature (LX–T) relation of galaxy clusters. A tight correlation is known to exist between the luminosity and temperature of the X-ray-emitting intracluster medium of galaxy clusters. While the measured luminosity depends on the underlying cosmology through the luminosity distance DL, the temperature can be determined without any cosmological assumptions. By exploiting this property and the homogeneous sky coverage of X-ray galaxy cluster samples, one can effectively test the isotropy of cosmological parameters over the full extragalactic sky, which is perfectly mirrored in the behavior of the normalization A of the LX–T relation. To do so, we used 313 homogeneously selected X-ray galaxy clusters from the Meta-Catalogue of X-ray detected Clusters of galaxies. We thoroughly performed additional cleaning in the measured parameters and obtain core-excised temperature measurements for all of the 313 clusters. The behavior of the LX–T relation heavily depends on the direction of the sky, which is consistent with previous studies. Strong anisotropies are detected at a ≳4σ confidence level toward the Galactic coordinates (l, b) ∼ (280°, − 20°), which is roughly consistent with the results of other probes, such as Supernovae Ia. Several effects that could potentially explain these strong anisotropies were examined. Such effects are, for example, the X-ray absorption treatment, the effect of galaxy groups and low redshift clusters, core metallicities, and apparent correlations with other cluster properties, but none is able to explain the obtained results. Analyzing 105 bootstrap realizations confirms the large statistical significance of the anisotropic behavior of this sky region. Interestingly, the two cluster samples previously used in the literature for this test appear to have a similar behavior throughout the sky, while being fully independent of each other and of our sample. Combining all three samples results in 842 different galaxy clusters with luminosity and temperature measurements. Performing a joint analysis, the final anisotropy is further intensified (∼5σ), toward (l, b) ∼ (303°, − 27°), which is in very good agreement with other cosmological probes. The maximum variation of DL seems to be ∼16 ± 3% for different regions in the sky. This result demonstrates that X-ray studies that assume perfect isotropy in the properties of galaxy clusters and their scaling relations can produce strongly biased results whether the underlying reason is cosmological or related to X-rays. The identification of the exact nature of these anisotropies is therefore crucial for any statistical cluster physics or cosmology study.

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Artificial intelligence to diagnosis distal radius fracture using biplane plain X-rays

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02845-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Kunihiro Oka ◽

Ryoya Shiode ◽

Yuichi Yoshii ◽

Hiroyuki Tanaka ◽

Toru Iwahashi ◽

...

Keyword(s):

Artificial Intelligence ◽

Diagnostic Accuracy ◽

Distal Radius ◽

Diagnostic Tests ◽

Styloid Process ◽

Final Diagnosis ◽

Distal Radius Fractures ◽

X Rays ◽

Radius Fractures ◽

X Ray

Abstract Background Although the automatic diagnosis of fractures using artificial intelligence (AI) has recently been reported to be more accurate than those by orthopedics specialists, big data with at least 1000 images or more are required for deep learning of the convolutional neural network (CNN) to improve diagnostic accuracy. The aim of this study was to develop an AI system capable of diagnosing distal radius fractures with high accuracy even when learning with relatively small data by learning to use bi-planar X-rays images. Methods VGG16, a learned image recognition model, was used as the CNN. It was modified into a network with two output layers to identify the fractures in plain X-ray images. We augmented 369 plain X-ray anteroposterior images and 360 lateral images of distal radius fractures, as well as 129 anteroposterior images and 125 lateral images of normal wrists to conduct training and diagnostic tests. Similarly, diagnostic tests for fractures of the styloid process of the ulna were conducted using 189 plain X-ray anteroposterior images of fractures and 302 images of the normal styloid process. The distal radius fracture is determined by entering an anteroposterior image of the wrist for testing into the trained AI. If it identifies a fracture, it is diagnosed as the same. However, if the anteroposterior image is determined as normal, the lateral image of the same patient is entered. If a fracture is identified, the final diagnosis is fracture; if the lateral image is identified as normal, the final diagnosis is normal. Results The diagnostic accuracy of distal radius fractures and fractures of the styloid process of the ulna were 98.0 ± 1.6% and 91.1 ± 2.5%, respectively. The areas under the receiver operating characteristic curve were 0.991 {n = 540; 95% confidence interval (CI), 0.984–0.999} and 0.956 (n = 450; 95% CI 0.938–0.973). Conclusions Our method resulted in a good diagnostic rate, even when using a relatively small amount of data.

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Distal Radius Fractures: Recognizing and Treating Complex Fracture Patterns

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000002209 ◽

2021 ◽

Vol 35 (3) ◽

pp. s33-s36

Author(s):

Ryan J. Lubbe ◽

Daniel T. Kokmeyer ◽

Colby P. Young

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Complex Fracture ◽

Fracture Patterns

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The Effect of Rotational Malalignment on X-rays of the Wrist

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408090393 ◽

2009 ◽

Vol 34 (2) ◽

pp. 166-172 ◽

Cited By ~ 11

Author(s):

J. T. CAPO ◽

K. ACCOUSTI ◽

G. JACOB ◽

V. TAN

Keyword(s):

Healthy Volunteers ◽

Distal Radius ◽

Treatment Decisions ◽

Carpal Bones ◽

X Rays ◽

Normal Range ◽

Rotational Malalignment ◽

X Ray ◽

Steady Decrease ◽

Rotational Malposition

This study evaluates the effect of rotational malposition of the wrist on measured radiographic parameters of the distal radius and carpus. Ten wrists from five healthy volunteers were imaged in varying degrees of rotation. The wrists were placed in a custom, calibrated jig and images were taken in 5° increments to a maximum pronation and supination of 20°. The results demonstrate the following: a steady decrease in the scapholunate and radioscaphoid angles with extremes of supination; an increase in palmar tilt with supination and a decrease in palmar tilt with pronation. The palmar tilt varied from −4° to 15° and the scapholunate angle ranged from 48° to 29° at the extremes of rotation. These results demonstrate how malrotation in X-ray positioning can have a significant effect on the apparent alignment of the distal radius and carpal bones. Measurements taken from poor X-rays typically fall outside the normal range and could adversely effect treatment decisions.

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Diaphyseal Screw Prominence in Distal Radius Volar Plating

Journal of Wrist Surgery ◽

10.1055/s-0040-1702930 ◽

2020 ◽

Vol 09 (03) ◽

pp. 214-218

Author(s):

Kevin Eng ◽

Stephen Gil ◽

Richard Page

Keyword(s):

Distal Radius ◽

Tendon Injury ◽

Dorsal Side ◽

X Rays ◽

Volar Plating ◽

Radius Fractures ◽

X Ray ◽

Screw Penetration ◽

With Screws ◽

Neutral Angle

Abstract Background Volar plating for distal radius fractures has become common. Screw prominence on the dorsal side from long screws can lead to tendon injury. Methods for detecting screws that penetrate the far cortex involve X-ray or ultrasound. These have focused on the distal row of screws. No studies have addressed screw penetration in the diaphysis. We describe two cases where diaphyseal screws caused symptoms. We then insert screws in the diaphysis of synbones 2 mm longer than measured and determine what angle of pronation or supination was best to detect this on X-ray. Methods Three synbones were plated using Synthes volar plate. The three diaphyseal screws were drilled perpendicular to the plate, and the depth measured. Cortical 2.4-mm screws were inserted, 2 mm longer than measured. The three synbones were then placed in a custom clamp to measure rotation. Lateral X-rays were taken at 0 degree rotation, and 5, 10, and 15 degrees of supination and pronation. The prominence of each screw was measured using the synapse digital ruler. Results For the screws that were placed at a neutral angle (perpendicular to the plate) the maximum visualization of the prominent tips occurred around 0 degree rotation. With screws angled 15 degrees ulna, maximum visualization was between 5 and 10 degrees of pronation. With screws angled 15 degrees radial, maximum visualization was between 5 and 10 degrees of supination. Every 5 degrees of rotation changes the profile of the screw by 0.4 mm. Discussion The diaphysis of the radius becomes approximately trapezoidal distally. Prominent screws that are placed below the “peak” of the trapezoid may appear to be the correct length. Rotating the wrist into pronation or supination to bring the relevant cortex as parallel to the X-ray beam as possible will help to identify if screws are of the correct length. Screws that are prominent in the second compartment may be particularly symptomatic as the tendons here are closely opposed to the bone. We recommend screening for 2 mm diaphyseal screw prominence in neutral, with 10 degrees of pronation and supination.

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COVID-19 Detection Using Deep Learning Algorithm on Chest X-ray Images

Biology ◽

10.3390/biology10111174 ◽

2021 ◽

Vol 10 (11) ◽

pp. 1174

Author(s):

Shamima Akter ◽

F. M. Javed Mehedi Shamrat ◽

Sovon Chakraborty ◽

Asif Karim ◽

Sami Azam

Keyword(s):

Deep Learning ◽

Learning Algorithm ◽

Statistical Significance ◽

Confusion Matrix ◽

Original Data ◽

Rank Test ◽

X Rays ◽

X Ray ◽

Professional Exposure ◽

Chest X Ray

COVID-19, regarded as the deadliest virus of the 21st century, has claimed the lives of millions of people around the globe in less than two years. Since the virus initially affects the lungs of patients, X-ray imaging of the chest is helpful for effective diagnosis. Any method for automatic, reliable, and accurate screening of COVID-19 infection would be beneficial for rapid detection and reducing medical or healthcare professional exposure to the virus. In the past, Convolutional Neural Networks (CNNs) proved to be quite successful in the classification of medical images. In this study, an automatic deep learning classification method for detecting COVID-19 from chest X-ray images is suggested using a CNN. A dataset consisting of 3616 COVID-19 chest X-ray images and 10,192 healthy chest X-ray images was used. The original data were then augmented to increase the data sample to 26,000 COVID-19 and 26,000 healthy X-ray images. The dataset was enhanced using histogram equalization, spectrum, grays, cyan and normalized with NCLAHE before being applied to CNN models. Initially using the dataset, the symptoms of COVID-19 were detected by employing eleven existing CNN models; VGG16, VGG19, MobileNetV2, InceptionV3, NFNet, ResNet50, ResNet101, DenseNet, EfficientNetB7, AlexNet, and GoogLeNet. From the models, MobileNetV2 was selected for further modification to obtain a higher accuracy of COVID-19 detection. Performance evaluation of the models was demonstrated using a confusion matrix. It was observed that the modified MobileNetV2 model proposed in the study gave the highest accuracy of 98% in classifying COVID-19 and healthy chest X-rays among all the implemented CNN models. The second-best performance was achieved from the pre-trained MobileNetV2 with an accuracy of 97%, followed by VGG19 and ResNet101 with 95% accuracy for both the models. The study compares the compilation time of the models. The proposed model required the least compilation time with 2 h, 50 min and 21 s. Finally, the Wilcoxon signed-rank test was performed to test the statistical significance. The results suggest that the proposed method can efficiently identify the symptoms of infection from chest X-ray images better than existing methods.

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Correction to: Virtual fracture clinic reduces patient X‑ray volume for common wrist and ankle fractures

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02841-7 ◽

2021 ◽

Author(s):

Conor S. O’Driscoll ◽

Andrew J. Hughes ◽

Fergus J. McCabe ◽

Elaine Hughes ◽

John F. Quinlan ◽

...

Keyword(s):

Ankle Fractures ◽

Fracture Clinic ◽

X Ray ◽

Virtual Fracture Clinic

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Peculiarities of the Structure of Dentition Defects in the Adult Population of Kharkiv

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs05.06.257 ◽

2020 ◽

Vol 5 (6) ◽

pp. 257-261

Author(s):

Yu. O. Slynko ◽

Keyword(s):

Structural Characteristics ◽

Statistical Significance ◽

Adult Population ◽

Age Groups ◽

X Rays ◽

X Ray ◽

Dental Patients ◽

Fifth Generation ◽

Orthopedic Care ◽

Methods Of Treatment

The presence of dentition defects and the choice of modern methods of restoring their integrity remains a topical issue in domestic and foreign dentistry. On the other hand, much attention is paid to imaging methods for examination of secondary defects of teeth, dentition, which are widely used to clarify the diagnosis, determine the plan and prognosis of treatment. The purpose of our research was to continue the study of the structural characteristics of small defects of the dentition in adults of Kharkiv based on the results of the analysis of X-ray examination. Material and methods. Orthopantomograms of 1269 patients (aged from 18 to 84 years) were analyzed, and X-rays were performed on a fifth-generation Dental Computed Tomography Vereviewepocs 3D R100 (Morita, Japan) between May 2017 and May 2019. The primary material was divided into 12 age groups according to the age of the patients, taking into account the WHO recommendation (1988). The analysis of the structure of small dentition defects in Kharkiv residents was carried out depending on such characteristics of dentition defects as the presence of included (limited) defects or final (unlimited) defects and their simultaneous presence in the patient. Results and discussion. The analysis of orthopantomograms of 1269 people revealed that the number of final small defects of the dentition was 4.29 times less with such limited defects (respectively 18.88% and 81.12%, p <0.05). On the basis of gender, statistical significance in the distribution between limited and unrestricted small dentition defects was generally not found (p> 0.05), but in the vast majority of cases, women who had these variants of defects were still more than men. We also noted that if the prevalence of included small defects of dentition became maximum at the age of 35 to 39 years, the final defects reached such a level only in old age, which may be associated with an increase in the number of teeth that are already contraindicated for conservative endodontic treatment and they were subject to removal. The results of this study coincided with the general trends in the development and structure of small defects of the dentition in the population of different regions of Ukraine. Conclusion. The obtained data can be a theoretical basis for the organization of orthopedic care and the choice of adequate to modern requirements methods of treatment of dental patients, especially young people, with the presence of small defects of the dentition

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A Prospective Patient Reported Outcomes (PRO) Study Assessing Outcomes of Surgically Managed Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00184 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0018

Author(s):

Jasen Gilley ◽

Raheem Bell ◽

Mateus Lima ◽

Joshua E. Barrett ◽

Bennett Butler ◽

...

Keyword(s):

Physical Function ◽

Ankle Fracture ◽

Statistical Significance ◽

Functional Mobility ◽

Ankle Fractures ◽

Pain Interference ◽

X Rays ◽

Syndesmotic Injury ◽

Significant Difference ◽

Patient Reported

Category: Ankle Introduction/Purpose: Ankle fractures are a common cause of functional mobility that have seen a dramatic rise incidence over the past decade1. The purpose of this study was to compare the outcomes and prognosis of various fracture sub-types by utilizing two validated patient reported outcome measures: the PROMIS Physical Function and Pain Interference Computer Adaptive Tests (CATs) for patients at a major tertiary facility and level I trauma center. Methods: 12-month post-operative PROMIS Physical Function and Pain Interference CATs were collected for 125 ankle fracture patients presenting between 2014 and 2017. Patients were initially stratified by ankle fracture sub-type after examining pre- operative X-rays and further refined by the presence or absence of concomitant deltoid injury or posterior malleolar fracture. Patients defined as members of vulnerable populations and patients presenting more than 2 weeks from time of injury/with prior acute ipsilateral fracture were excluded. The distribution of PROMIS physical function and pain interference T-scores were assessed via a Shapiro-Wilk test and a one-way ANOVA was used for further evaluation. If significant differences were found between groups, pair-wise comparisons were tested via Dwass, Steel, Critchlow-Fligner multiple comparison analysis. Results: Fracture types and corresponding n-value in this study: (44) isolated lateral malleolar, (12) isolated medial malleolar, (12) bimalleolar, (44) trimalleolar, (6) isolated syndesmotic injury, and (8) isolated posterior malleolar fractures. Mean values for the PROMIS physical function and pain interference domains for each fracture sub-type were calculated and compared to reference population mean T-scores of 50 (SD = 10): isolated lateral malleolar (PF:50/PI:51), isolated medial malleolar (PF:52/PI:49), bimalleolar (PF:48/PI:50), trimalleoar (PF:47/PI:51), isolated posterior malleolar (PF:53/PI:44), and isolated syndesmotic injury (PF:60/PI:46). The Shapiro-Wilk test indicated a non-normal distribution for the post-operative PROMIS physical function T-scores across all fracture patients (p-value = 0.0421). Pair-wise comparisons were done to compare relative prognosis between fracture sub-types but failed to yield statistically significant differences in physical function or pain domains. Conclusion: Surgical intervention is effective in returning patients to normal levels of physical function and pain interference across all sub-types according to post-op T-scores. Although our analysis indicated a significant difference when comparing across all fracture sub-types, none of the pairwise sub-type comparisons showed statistical significance. Analyses of fracture sub-types determined trimalleolar injuries report the poorest outcomes for both PROMIS domains while the isolated syndesmotic and posterior malleolar groups reported the best outcomes. Further investigation with a larger sample size for each group is needed to delineate whether a significant difference exists for PROMIS physical function and pain interference scores.

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White-Light Coronal Structures: Streamers and CMEs

International Astronomical Union Colloquium ◽

10.1017/s0252921100025045 ◽

1994 ◽

Vol 144 ◽

pp. 82

Author(s):

E. Hildner

Keyword(s):

Emission Line ◽

Electron Density ◽

White Light ◽

Coronal Mass Ejections ◽

X Rays ◽

Solar Cycles ◽

Temperature Function ◽

X Ray ◽

Eclipse Observations ◽

Coronal Structures

AbstractOver the last twenty years, orbiting coronagraphs have vastly increased the amount of observational material for the whitelight corona. Spanning almost two solar cycles, and augmented by ground-based K-coronameter, emission-line, and eclipse observations, these data allow us to assess,inter alia: the typical and atypical behavior of the corona; how the corona evolves on time scales from minutes to a decade; and (in some respects) the relation between photospheric, coronal, and interplanetary features. This talk will review recent results on these three topics. A remark or two will attempt to relate the whitelight corona between 1.5 and 6 R⊙to the corona seen at lower altitudes in soft X-rays (e.g., with Yohkoh). The whitelight emission depends only on integrated electron density independent of temperature, whereas the soft X-ray emission depends upon the integral of electron density squared times a temperature function. The properties of coronal mass ejections (CMEs) will be reviewed briefly and their relationships to other solar and interplanetary phenomena will be noted.

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