scholarly journals A comparison of erect weight-bearing and non-weight-bearing radiography of the cervical spine in non-trauma patients

2021 ◽  
Author(s):  
Bimali S. Weerakoon ◽  
Nimali N. Karunaratne ◽  
Winitha S. Jayasundara
Keyword(s):  
Imaging System ◽  
Computed Radiography ◽  
Cervical Vertebrae ◽  
Weight Bearing ◽  
Cervical Region ◽  
Trauma Patients ◽  
Imaging Procedure ◽  
Significant Difference ◽  
Vertebral Bodies ◽  
Fair Poor

Introduction: Various positioning techniques are utilized to enhance the visualization of lower cervical vertebrae on lateral radiographs. However, the effectiveness of these techniques still remains unclear. This study was conducted to determine the effect of the weight-bearing (WB) technique in visualizing lower cervical vertebrae and cervicothoracic junction (C7-T1) on standing lateral cervical radiographs of adult non-trauma patients. The study was conducted using both computed radiography (CR) and digital radiography (DR) systems.Methods: Forty-four CR (29 WB and 15 non-WB – NWB) and 61 DR (26 WB and 35 NWB) lateral C-spine radiographs were prospectively evaluated to assess the visible number of cervical vertebral bodies and C7-T1 junction. The instructions given by the radiographer to the patient for the imaging procedure were also assessed on the Likert scale (very good, good, fair, poor, very poor).Results: There was no significant difference (p > 0.05) in the visualization of the number of vertebral bodies between the two techniques of WB and NWB for CR or DR. Further, no significant relationship (p > 0.05) was observed between the WB technique and the visualization of C7-T1 junction in DR systems. However, a significant difference was identified for CR (p = 0.012). The instruction given to the patient significantly correlated with the visibility of the lower C-spine region within each group of WB and NWB in both imaging systems.Conclusions: The visibility of the number of vertebral bodies in the lower C-spine region in either CR or DR systems did not demonstrate any enhancement with the WB technique. Regardless of the imaging system or techniques used, adequate instructions given to the patient before and during the imaging procedure of C-spine lateral radiography demonstrated a significant improvement in visualizing the lower C-spine region. In this preliminary study, the application of erect WB radiography technique in evaluating the lower cervical region of adult non-trauma patients gives limited advantage.

317 Cost-Effectiveness of a Novel Cervical Spine Clearance Protocol: Obviating the Need for Routine Magnetic Resonance Imaging

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 268-268
Author(s):  
Jared Ament ◽  
Bart Thaci ◽  
Mena Said ◽  
Ripul Rajen Panchal ◽  
Kee Duk Kim ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cost Effectiveness ◽  
Weight Bearing ◽  
Ct Scans ◽  
Spine Injury ◽  
Trauma Patients ◽  
Mri Findings ◽  
Routine Magnetic Resonance Imaging ◽  
Significant Difference ◽  
Flexion Extension

Abstract INTRODUCTION Cervical spine injury (CSI) occurs in 2–4% of trauma patients in the USA causing significant decrements in quality of life and even death. Treatment of CSI is estimated to cost $9.7 billion annually. Computed tomography (CT) has an almost 100% negative predictive value (NPV) for cervical spine (c-spine) clearance, in both alert and obtunded patients. However, MRI can depict occult discoligamentous injury in some patients with negative CT scans. It remains unclear whether MRI findings should preclude c-spine clearance and prolong hospital stay. This review intends to critically assess CT-missed CSI patients and derive a safe, economically sustainable protocol for c-spine clearance. METHODS A retrospective review of prospectively collected CSI data from two, level-1 trauma centers, was conducted from 2015–2016. Primary outcome measures include: NPV and the incremental cost-effectiveness ratio (ICER) of a novel c-spine clearance protocol compared with standard of care. The protocol included thin-cut CT scans with either weight-bearing or flexion-extension films. The ICER was calculated using standard cost-utility analysis techniques in US dollars ($) per quality-adjusted-life-year (QALY), assuming a willingness-to-pay threshold of 50,000$/QALY. RESULTS >A total of 614 patients were reviewed. Mean age was 38.3 years (SD 18.6), 147 (23.9%) had altered mentation, and 12 (2%) had clinically meaningful CT-missed acute discoligamentous disruption. Our c-spine clearance protocol had a NPV of 99.8% (CI 96.5-100%). There was no statistically significant difference between awake and obtunded patients (P = 0.74). Mean time to c-spine clearance improved by 1.3 days (SD 0.9). Duration of c-spine immobilization was reduced by 930 person-days. Mean cost savings was $1230 (SD $242) per patient. Mean change in QALY was 0.02 (SD 0.01). The ICER was 61,500$/QALY. CONCLUSION Our novel CSI clearance protocol is both safe and highly cost-effective. It improves outcomes at less cost, making it a dominant strategy that centers should consider implementing.

scholarly journals Evaluation of the Reliability of Lower Extremity Alignment Measurements Using EOS Imaging System While Standing in an Even Weight-Bearing Posture

2021 ◽  
Author(s):  
Byung Woo Cho ◽  
Tae-Ho Lee ◽  
Sungjun Kim ◽  
Chong-Hyuk Choi ◽  
Min Jung ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Imaging System ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Lower Extremities ◽  
Tibial Rotation ◽  
Tibial Torsion ◽  
Good Reliability ◽  
Eos Imaging ◽  
Significant Difference

Abstract Purpose: This study aimed to analyze the reproducibility and reliability of the alignment parameters measured using the EOS image system in both limbs while standing with an even weight-bearing posture.Methods: Overall, 104 lower extremities in 52 patients were analyzed retrospectively. The patients stood with an even load over both lower extremities then rotated 15° in both directions. Two EOS images were acquired and 104 pairs of lower extremities were compared according to the position of the indexed lower extremities. Then, the inter-observer reliability of the EOS system and the inter-modality reliability between EOS and computed tomography (CT) were evaluated.Results: Femoro-tibial rotation (FTR) and tibial torsion demonstrated a significant difference between the anterior and posterior positions of the indexed lower extremity. All values except for FTR and tibial torsion demonstrated good or very good reliability. In the anterior position, FTR demonstrated moderate, and tibial torsion demonstrated poor reliability. In the posterior position, both FTR and tibial torsion demonstrated poor reliability. In the reliability analysis between the three-dimensional (3D) EOS model and 3D CT images, all measurements of the femur demonstrated very good reliability, but measurements of the tibia did not.Conclusions: For the coronal and sagittal alignment parameters measured by the EOS 3D system with rotated standing posture, except for the measurement including tibial torsion., there were no significant difference for either position of the indexed extremities with high agreement between the observers as well as with the CT 3D model.

Computed Radiography for Characterisation of the Weight-Bearing Knee

1997 ◽  
Vol 38 (4) ◽  
pp. 514-519 ◽  
Author(s):  
Jan Sanfridsson ◽  
G. Svahn ◽  
K. Jonsson ◽  
L. Ryd
Keyword(s):  
Computed Radiography ◽  
Weight Bearing

scholarly journals A Tumbling Magnetic Microrobot System for Biomedical Applications

Micromachines ◽  
2020 ◽  
Vol 11 (9) ◽  
pp. 861
Author(s):  
Elizabeth E. Niedert ◽  
Chenghao Bi ◽  
Georges Adam ◽  
Elly Lambert ◽  
Luis Solorio ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Biomedical Applications ◽  
Imaging System ◽  
Ex Vivo ◽  
Negative Control ◽  
Circular Path ◽  
Rotational Axis ◽  
Significant Difference

A microrobot system comprising an untethered tumbling magnetic microrobot, a two-degree-of-freedom rotating permanent magnet, and an ultrasound imaging system has been developed for in vitro and in vivo biomedical applications. The microrobot tumbles end-over-end in a net forward motion due to applied magnetic torque from the rotating magnet. By turning the rotational axis of the magnet, two-dimensional directional control is possible and the microrobot was steered along various trajectories, including a circular path and P-shaped path. The microrobot is capable of moving over the unstructured terrain within a murine colon in in vitro, in situ, and in vivo conditions, as well as a porcine colon in ex vivo conditions. High-frequency ultrasound imaging allows for real-time determination of the microrobot’s position while it is optically occluded by animal tissue. When coated with a fluorescein payload, the microrobot was shown to release the majority of the payload over a 1-h time period in phosphate-buffered saline. Cytotoxicity tests demonstrated that the microrobot’s constituent materials, SU-8 and polydimethylsiloxane (PDMS), did not show a statistically significant difference in toxicity to murine fibroblasts from the negative control, even when the materials were doped with magnetic neodymium microparticles. The microrobot system’s capabilities make it promising for targeted drug delivery and other in vivo biomedical applications.

Betadine has a ciliotoxic effect on ciliated human respiratory cells

2014 ◽  
Vol 129 (S1) ◽  
pp. S45-S50 ◽  
Author(s):  
J H Kim ◽  
J Rimmer ◽  
N Mrad ◽  
S Ahmadzada ◽  
R J Harvey
Keyword(s):  
Epithelial Cells ◽  
High Speed ◽  
Imaging System ◽  
Beat Frequency ◽  
Ciliary Beat Frequency ◽  
Positive Control ◽  
Clinical Dose ◽  
Significant Difference ◽  
Sinonasal Mucosa ◽  
Ciliary Beat

AbstractObjective:This study investigated the effect of Betadine on ciliated human respiratory epithelial cells.Methods:Epithelial cells from human sinonasal mucosa were cultured at the air–liquid interface. The cultures were tested with Hanks' balanced salt solution containing 10 mM HEPES (control), 100 µM ATP (positive control), 5 per cent Betadine or 10 per cent Betadine (clinical dose). Ciliary beat frequency was analysed using a high-speed camera on a computer imaging system.Results:Undiluted 10 per cent Betadine (n = 6) decreased the proportion of actively beating cilia over 1 minute (p < 0.01). Ciliary beat frequency decreased from 11.15 ± 4.64 Hz to no detectable activity. The result was similar with 5 per cent Betadine (n = 7), with no significant difference compared with the 10 per cent solution findings.Conclusion:Betadine, at either 5 and 10 per cent, was ciliotoxic. Caution should be applied to the use of topical Betadine solution on the respiratory mucosal surface.

Continuous Femoral Nerve Blockade versus Continuous Epidural Analgesia for Postoperative Pain Relief in Knee Surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hala Gomaa Salama ◽  
Ahmed Ali El- Shebiny ◽  
Abd Al Aziz Abdullah Abd Al Aziz ◽  
Mariam Mahmoud Ahmed Ali Shehata
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Weight Bearing ◽  
Femoral Nerve ◽  
Disease Process ◽  
Continuous Epidural Analgesia ◽  
Significant Difference ◽  
Continuous Femoral Nerve Block

Abstract Background The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain). Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved. Objective Compare the benefits of continuous femoral nerve block (CFNB) with those of continuous epidural analgesia CEPA for postoperative pain management after Knee surgeries. Methods This study is a randomized controlled clinical trial was conducted in Ain Shams University Hospitals after obtaining approval from the Research Ethical Committee of Ain Shams University during a period of three months. Patients undergoing primary unilateral TKA for osteoarthritis, were recruited at least one day prior to the scheduled surgery, male and female patients. Results There was significant difference in terms of pain scoring between continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) in the first 6 hours, 12 hours, 24 hours, 48 hours, 72 hours but non significant difference in incidence of side effects Conclusion Our study showed that CEA had optimal analgesia and pain control than CFNB in management of post operative pain after total knee replacement.

Evaluation of skin displacement in the equine neck

2014 ◽  
Vol 10 (3) ◽  
pp. 181-186 ◽  
Author(s):  
A. Bergh ◽  
A. Egenvall ◽  
E. Olsson ◽  
M. Uhlhorn ◽  
M. Rhodin
Keyword(s):  
Mixed Models ◽  
Sagittal Plane ◽  
Cervical Vertebrae ◽  
Statistical Significance ◽  
Longitudinal Axis ◽  
Joint Motion ◽  
Skin Marker ◽  
Significant Difference ◽  
Axis Parallel ◽  
Kinematic Studies

Kinematic studies, using reflective skin markers, are commonly used to investigate equine joint motion in equitation science and for rehabilitation purposes. In order to interpret the registrations accurately, the degree of skin displacement has been described for the limbs and back, but not yet for the neck. The aim of the present study was to measure sagittal plane skin displacement in the equine neck. Radiopaque skin markers were applied to the skin over the first six cervical vertebrae of six healthy horses. Latero-lateral radiographs were taken in three standardised neck positions in the sagittal plane: control (horizontal neck), ‘on the bit’ and ‘nose to carpus’. The scales of the images were normalised and calculation of skin displacement was done by use of a coordinate system, dividing the displacement along an x-axis parallel to the vertebra's longitudinal axis and a y-axis perpendicular to the x-axis. Mixed models analysis was employed to study the differences in distances in x- and y-directions, and statistical significance was set to PÃ0.05. Between control and ‘nose to carpus’ positions, there were significant differences in skin marker locations, relative to the underlying vertebrae, in the x-direction for C1-6, and in y-direction for C3-6. Between normal and ‘on the bit’ positions, there were significant difference in both x- and y-directions for C6. Differences in marker locations along x- and y-axes, respectively, were 3±9 mm and 44±14 mm. The outcome of this study indicates that skin displacement should be considered when investigating equine neck motion with skin marker methodology.

scholarly journals Objective assessment of stiffness in Achilles tendinopathy: a novel approach using the MyotonPRO

2018 ◽  
Vol 4 (1) ◽  
pp. e000446 ◽  
Author(s):  
Gafin Ericson Morgan ◽  
Rhodri Martin ◽  
Lisa Williams ◽  
Owen Pearce ◽  
Keith Morris
Keyword(s):  
Dynamic Stiffness ◽  
Objective Assessment ◽  
Weight Bearing ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Asymptomatic Group ◽  
Musculotendinous Junction ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

ObjectivesThe aim of this study was to establish quantitative values for asymptomatic and symptomatic Achilles tendons.DesignCohort study with a single (cross-sectional) time point of patients diagnosed with unilateral Achilles tendinopathy and an asymptomatic group with comparative homogeneity.MethodsA sample of 50 participants: 25 diagnosed with symptomatic unilateral Achilles tendinopathy (AT group) and 25 with asymptomatic Achilles tendons (control group 2). The asymptomatic side of the AT group was used as a control (control group 1). Measurements at 2 cm intervals on the tendon from its insertion at the calcaneum up to the musculotendinous junction were taken non-weight bearing (NWB) and weight bearing (WB) using the MyotonPRO.ResultsThere was a significant (p<0.005) decrease in natural oscillation frequency (F) at points 2, 3 and 4 of the AT group (NWB condition) and points 2 and 3 for the WB condition. There was a significant (p<0.005) increase in logarithmic decrement (D) at points 2 and 3 signifying a decrease in elasticity. Dynamic stiffness (S) was significantly (p<0.005) reduced in the AT group at points 2 and 3 WB and point 3 WB. There was no significant difference in creep (C) observed between the symptomatic and asymptomatic tendons. There was a significant (p<0.005) increase in mechanical stress relaxation time (R) at point 2 NWB.There was a correlation between body weight and gender on tendon mechanics, with the symptomatic tendons. No significant differences were observed between the control group 1 and control group 2.ConclusionsThe MyotonPRO measured decreased stiffness over a section of the tendon corresponding clinically with Achilles tendinopathy. This may have potential in identifying risk of injury and informing rehabilitation, however further extensive research is required to generate baseline data for specific population groups monitoring variables over time. Age, gender and body mass index appear to have some bearing on the mechanical properties of the tendon but mainly in the tendinopathy group.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

Sign in / Sign up

Export Citation Format

Share Document