Estimating rotation angle from asymmetric projection of chest

BACKGROUND: Manual or machine-based analysis of chest radiographs needs the images acquired with technical adequacy. Currently, the equidistance between the medial end of clavicles and the center of spinous processes serves as the only criterion to assess whether a frontal PA chest radiograph is taken with any rotation. However, this measurement is normally difficult to implement because there exists overlapping of anatomies within the region. Moreover, there is no way available to predict exact rotating angles even the distances were correctly measured from PA chest radiographs. OBJECTIVE: To quantitatively assess positioning adequacy of PA chest examination, this study proposes and investigates a new method to estimate rotation angles from asymmetric projection of thoracic cage on radiographs. METHOD: By looking into the process of radiographic projection, generalized expressions have been established to correlate rotating angles of thorax with projection difference of left and right sides of thoracic cage. A trunk phantom with different positioning angles is employed to acquire radiographs as standard reference to verify the theoretical expressions. RESULTS: The angles estimated from asymmetric projections of thoracic cage yield good agreement with those actual rotated angles, and an approximate linear relationship exists between rotation angle and asymmetric projection of thoracic cage. Under the experimental projection settings, every degree of rotation corresponds to the width difference of two sides of thoracic cage around 13–14 pixels. CONCLUSION: The proposed new method may be used to quantify rotating angles of chest and assess image quality for thoracic radiographic examination.

Compound Heterozygous Splicing Variants In KIAA0586 Cause Fetal Short-Rib Thoracic Dysplasia And Cerebellar Malformation: The Use of Whole Exome Sequencing In Prenatal Diagnosis

Background: Short-rib thoracic dysplasia (SRTD) and Joubert syndrome (JS) are rare genetic ciliopathies, both patients can manifest cerebellar malformation and variable developmental delays. However, neither could be easily diagnosed during pregnancy due to limited fetal phenotype. Here, we investigated a fetus with short limbs, polydactyly initially and uncovered a compound heterozygous pathogenesis through whole exome sequencing (WES).Results: Merely short limbs and polydactyly of the fetus were detected during second trimester of gestation. Two variants (c.3940+1G>A and c.3303G>A), affecting splicing of KIAA0586 gene, were identified from amniocytes through WES. The presence and effect of these mutations were further validated on DNA and RNA level through Sanger sequencing. More intensive fetal monitoring was applied; deformed cerebellar malformation and restricted thoracic cage of the fetus were additionally uncovered. Conclusion: Herein, we discovered a genetic pathogenesis of KIAA0586 gene associated with SRTD and/or JS in a fetus with mild ultrasound anomalies initially. With the information of prenatal WES and distinct phenotypes of the fetus uncovered by imaging examination, we could reach more accurate clinical diagnosis and provide valuable prognosis information for parents.

A STUDY OF SURGICAL MANAGEMENT OF RIB FRACTURES FOLLOWING TRAUMA PATIENTS IN OUR INSTITUTION

Background: Surgical management of chest wall injuries has received increasing attention in recent years. The aim of this thesis was to study the mechanism of injury (MOI) in relation to chest wall injury patterns and short- and long-term outcome of surgery in patients with multiple rib fractures and unstable thoracic cage injuries. Methods: Paper I is a retrospective study (n=211) of the association of MOI and injury patterns in patients operated for acute chest wall injuries. Paper II is a prospective longitudinal study (n=54) of the long-term outcome of surgery in patients with multiple rib fractures and ail chest. Paper III is a cross-sectional study (n=37) of the use of CT-lung volume estimation as a marker for lung function in patients operated for ail chest. Paper IVis a prospective controlled study (n=139) of the short- and long-term outcome of surgery in patients with unstable thoracic cage injuries. Results: The MOI differs according to age and is associated with different chest wall injury patterns. Lateral and posterior ail segments are the most commonly seen. Symptoms of pain, lung function and Quality of Life (QoL), improve during the rst post-operative year. CT-lung volume estimates increase signicantly from pre- operative values to post-operative values and there is a high correlation between post-operative CT-lung volume and lung function. Surgery for unstable thoracic cage injuries does not decrease the need for mechanical ventilation. However, surgically managed with rib plating patients have a decreased incidence of pneumonia (17% vs. 36%, p=0.013) and less pain (29% vs. 57%, p<0.05) the rst months' post trauma. Patients operated without thoracotomy have a better residual lung function and lung volume. A gradual improvement in patient symptoms was seen and after one year there was no difference in symptoms, function or QoL between surgically managed with rib plating and conservatively managed patients. Conclusions: The MOI inuences rib fracture pattern and associated injuries. Lung volume estimated by CT can be used as a marker for lung function. Surgery for unstable thoracic cage injuries decreases the incidence of pneumonia and reduces pain. Patients continue to improve graduallyandnodifference canbe seenbetweenthe surgicallymanagedwithribplatingandconservativelymanagedpatients oneyearposttrauma.

Airway Management of the Deformed Trachea Using T-Tube Stents in Patients with Mucopolysaccharidosis Type IVA

Introduction: Mucopolysaccharidosis (MPS) type IVA usually results in airway obstruction due to thoracic cage deformity and crowding of intrathoracic structures, causing tracheal compression by the tortuous innominate artery. Objectives: To offer an alternative and effective method in dealing with the challenged deformity of the airway in patients with MPS type IVA. Methods: We present 3 patients with MPS type IVA who underwent airway stenting using Montgomery® T-tube stents. Three-dimensional reconstructed computed tomography was essential to design the T-tube and evaluate the anatomical relationship between the innominate artery and the trachea. The Y-shaped Montgomery® Pediatric Safe-T-Tube™ is more suitable for MPS type IVA. Regular follow-ups using fiberoptic bronchoscopy are necessary to evaluate the complications. Results: All 3 patients had good outcomes during the follow-ups until present, despite the complication of granulation formation, which was resolved by revising the limbs of the T-tube. Conclusions: T-tube stents placed below the vocal cord may restore airway patency and preserve laryngeal function, including respiration, phonation, and swallowing, in patients with MPS type IVA.

A new technique for neonatal Jeune syndrome: External thoracic expansion

Jeune syndrome is a rare form of skeletal dysplasia characterized by a narrow, bell-shaped chest (thoracic cage), and typical phalangeal and pelvic bone deformities. Chest expansion is impaired by the short, horizontally positioned ribs, resulting in alveolar hypoventilation and eventually neonatal-infantile death in most cases. External distraction with sternoplasty is a new technique for the treatment of Jeune syndrome, which was firstly used by our team on a newborn by placing a sliding finger fixator which was designed for ulnar lengthening. We believe that this approach can be life-saving in neonates with improved and widespread usage.