Enhancing the radiological classification system from the distal femur to the proximal tibia

Introduction The inner diaphyseal diameter of the distal femur, at 20 cm from the lateral joint line, is the strongest risk factor for predicting aseptic loosening in total knee arthroplasty using rotating hinge prosthesis. In this context, the Citak classification has been introduced presenting three different types of the distal femur anatomy. The aim of the study is to develop a novel classification system for the proximal tibia. Materials and Methods Two-hundred patients with standard knee antero-posterior radiographs were included in this study. We measured the inner diameter of the tibia 16 cm distally from the tibial plateau and 3 cm distally from the tibial spine. The ratio between these two measurements was applied as the novel index ratio. Results According to the 25th and 75th percentiles, three groups can be clustered for each gender. A higher distribution of the type B pattern was found in female and male patients. However, type A with a narrow inner diaphyseal diameter was less common in female patients The median intra-observer reliability for rater 1 was 0.997. The inter-observer reliability was high (ICC 0.998). There was a moderate correlation between the AP diameter and height (r = 0,568); a low correlation between the AP diameter and weight (r = 0.376). The novel index shows no significant correlation between the index ratio and height (r = 0.082), weight (r = 0.014) or BMI (r= - 0.038). The novel index shows no statistically significant correlation between the index ratio and height (r = 0.082) or weight (r = 0.014) or BMI (r= - 0.038). Conclusion The novel classification presents three different types of tibia for each gender: type C has a wider inner diaphyseal diameter compared to type A with a narrow inner diaphyseal diameter. Type B has the widest distribution among the subjects.

Ultrasound-Derived Diaphragm Contractile Reserve as a Marker of Clinical Status in Patients With Cystic Fibrosis

Introduction: In patients with cystic fibrosis (CF), the monitoring of respiratory muscle activity using electromyography can provide information on the demand-to-capacity ratio of the respiratory system and act as a clinical marker of disease activity, but this technique is not adapted to routine clinical care. Ultrasonography of the diaphragm could provide an alternative, simpler and more widely available alternative allowing the real-time assessment of the diaphragm contractile reserve (DCR), but its relationship with recognized markers of disease severity and clinical outcomes are currently unknown.Methods: Stable patients with CF were prospectively recruited. Diaphragm ultrasound was performed and compared to forced expiratory volume in 1 s (FEV1), residual volume (RV), handgrip strength, fat-free mass index (FFMI), serum vitamin levels, dyspnea levels and rate of acute exacerbation (AE). Diaphragm activity was reported as DCR (the ratio of tidal-to-maximal thickening fractions, representing the remaining diaphragm contractility available after tidal inspiration) and TFmax (representing maximal diaphragm contractile strength). Inter-observer reliability of the measurement of DCR was evaluated using intra-class correlation analysis.Results: 110 patients were included [61 males, median (interquartile range), age 31 (27–38) years, FEV1 66 (46–82)% predicted]. DCR was significantly correlated to FEV1 (rho = 0.46, p < 0.001), RV (rho = −0.46, p < 0.001), FFMI (rho = 0.41, p < 0.001), and handgrip strength (rho = 0.22, p = 0.02), but TFmax was not. In a multiple linear regression analysis, both RV and FFMI were independent predictors of DCR. DCR, but not TFmax, was statistically lower in patients with > 2 exacerbations/year (56 ± 25 vs. 71 ± 17%, p = 0.001) and significantly lower with higher dyspnea levels. A ROC analysis showed that DCR performed better than FEV1 (mean difference in AUROC 0.09, p = 0.04), RV (mean difference in AUROC 0.11, p = 0.03), and TFmax at identifying patients with an mMRC score > 2. Inter-observer reliability of DCR was high (ICC = 0.89, 95% CI 0.84–0.92, p < 0.001).Conclusion: In patients with CF, DCR is a reliable and non-invasive marker of disease severity that is related to respiratory and extra-pulmonary manifestations of the disease and to clinical outcomes. Future studies investigating the use of DCR as a longitudinal marker of disease progression, response to interventions or target for therapy would further validate its translation into clinical practice.

Evaluating the Validity and Reliability of the Persian Version of American Orthopedic Foot and Ankle Society Midfoot Scale

Background The use of a valid and reliable outcome scoring system is crucial for evaluating the result of different treatment interventions. The aims of this study were to translate and culturally adapt the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system into the Persian language and assess its validity and reliability. Method In total, 57 patients with midfoot injuries were enrolled. Forward-backward translation and cultural adaptation methods were used to develop the Persian version of AOFAS midfoot scoring system. Reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach’s alpha. The discriminant and convergent validities of the scoring system were assessed using the total score of the mental and physical component of SF-36. Results The mean age of the participants was 46.2 ± 16.3 years. The intra-observer reliability of the totals core of the Persian version of AOFAS midfoot scoring system was 0.96 (confidence interval [CI]: 0.92-0.97) and the inter-observer reliability of the scoring system was 0.90 (CI: 0.86-0.95). The Persian version of AOFAS midfoot scoring system had acceptable convergence with physical component scoring system of SF-36 and its subscales (0.57); moreover, it had acceptable discriminant validity with the mental component of SF-36 and its subscales (0.36). Conclusion The Persian version of AOFAS midfoot is a reliable and valid instrument and could be used by Persian language clinicians and researchers. Level of Clinical Evidence: 3

Computer-aided Measurement System Using Image Processing for Measuring Cobb Angle in Scoliosis

Background: One of the spine deformities is scoliosis, and Cobb angle is generally used to assess it. Objectives: In this study, a computer-aided measurement system (CAMS) was presented as a new repeatable and reproducible approach to assess the Cobb angle in idiopathic scoliosis patients. Methods: Python libraries, including OpenCV and Numpy were used for image processing and design of the software. To assess the repeatability and reproducibility of the CAMS, a series of 98 anterior-posterior radiographs from patients with idiopathic scoliosis were used. Assessments were done by five independent observers. Each radiograph was assessed by each observer three times with a minimum break of two weeks among assessment. The single measure intraclass correlation coefficient (ICC), the mean absolute difference (MAD), and the standard error measurement (SEM) values were used for intra- and inter-observer reliability. Results: The inter-observer analysis indicated that the ICCs ranged from 0.94 - 0.99, and the MAD between manual and CAMS were less than 3°. For intra-observer measurements, the combined SEM between all observers for the manual and CAMS was 1.79° and 1.27°, respectively. An ICC value of 0.97 with 95% confidence interval (CI) was excellent in CAMS for inter-observer reliability. The MAD of CAMS was 2.18 ± 2.01 degrees. Conclusions: The CAMS is an effective and reliable approach for assessing scoliotic curvature in the standing radiographs of thoraco-lumbar. Moreover, CAMS can accelerate clinical visits, and its calculation results are reliable.

Validity and reliability of a smartphone goniometer application for measuring hip range of motions

BACKGROUND: Mobile applications which are designed to assess the range of motion (ROM) are widely used. OBJECTIVE: The aim of this cross-sectional observational study was to determine the inter-observer and intra-observer reliability of a smartphone application “PT Goniometer” (PTG) and determine the correlation between PTG and universal goniometer (UG) regarding active ROMs of the hip in healthy participants. METHODS: Thirty-four healthy young participants were included in the study. Two physiotherapists performed active hip flexion, abduction, internal rotation and external rotation ROM measurements of dominant legs of the participants by using PTG and UG. Intraclass correlation coefficients (ICC) were calculated to determine the intra-observer and inter-observer reliability. Level of correlations between PTG and UG were used to establish concurrent validity of PTG. RESULTS: The PTG demonstrated excellent inter-observer and intra-observer reliability (ICC > 0.90) for all measured hip movements. The minimum detectable change (MDC95) was ranged from 3.29° to 5.1° for the intra-observer reliability, and from 2.55° to 3.21° for the inter-observer reliability. Additionally, the concurrent validity was found excellent (r = 0.91–0.93). CONCLUSION: The results of the present study suggest that PTG is a valid and a reliable mobile technology for measuring hip ROMs.

Diameter measurements in three-dimensional printed flow phantom model of the carotid artery in preterm infants

Diameter form an integral part of blood flow measurement. This study aimed to explore different three-dimensional (3D) printed materials to develop flow phantom models of the carotid artery in preterm newborn infants and to investigate ideal diameter measurement points using ultrasound that reflected accurate lumen diameter measurement. Cerebral blood flow measurements data using Doppler ultrasound of the right common carotid artery from 21 randomly selected preterm infants were used to produce a 3D printed Doppler flow phantom model with three different vessel diameters. Diameters were measured by multiple observers blinded to phantom vessel characteristics and each other’s measurements. 9 measurement points were studied. Agreement between observers, inter and intra observer reliability and coefficient of variation (CoV) was examined. Of the 63 diameter measurements, 45 (71%) were performed on flow phantoms with vessel diameter of 0.196 cm. Bland-Altman plots revealed that measurement performed using leading edge to centre (mean bias 1.8% {95%LOA -4.1% to 7.7%}) and centre to trailing edge (mean bias 1.1% {95%LOA -5.4% to 7.8%}) resulted in the most accurate lumen diameter measurements. Inter and intra-observer reliability was excellent. The mean CoV for inter observer measurements was 1.7% and intra observer measurements was 1.6% and 1.8% for each observer. We successfully produced a 3D printed flow phantom model of the carotid artery in preterm infants and identified two measurement methods that result in reliable and accurate lumen diameter measurement. Researchers and clinicians can use this information for further studies involving ultrasound diameter measurements in small calibre vessels.

Correlation and agreement between superb micro-vascular imaging and contrast-enhanced ultrasound for assessing radiofrequency ablation treatment of thyroid nodules: a preliminary study

Background To evaluate the correlation and agreement between superb micro-vascular imaging (SMI) mode and the contrast-enhanced ultrasound (CEUS) mode for the ablative completeness and the volumes of ablation lesions to determine the clinical application value of SMI in follow-up after radiofrequency ablation. Methods From April 2020 to June 2020, two radiologists used SMI and CEUS mode to measure the volume of the ablation lesion. We use intra-class correlation coefficient (ICC), scatter plots and Bland–Altman plots to evaluate the correlation and agreement of the two techniques. In addition, intra- and inter-observer reliability in volume measurement of ablation lesions with SMI mode was assessed. Results SMI mode and CEUS mode have good agreement in the evaluation of ablative completeness. The ICC was 0.876 and 0.928 of reader A and reader B between SMI mode and CEUS mode in terms of ablation lesions volume measurement. There was a strong correlation between the two modes in both reader A and reader B (rA = 0.808; rB = 0.882). The ICC was 0.836 for the inter-observer reliability of SMI technique. The scatter plot showed a good linear relation (r = 0.715). In the Bland–Altman plot, 4.35% (1/23) of the points was outside the 95% limits of agreement. The ICC was 0.965 for the intra-observer reliability of SMI technique, the scatter plot also showed a strong linear correlation (r = 0.965). In the Bland–Altman plot, 8.70% (2/23) of the points was outside the 95% limits of agreement. Conclusions SMI and CEUS have good agreement and correlation in the ablation volume measurement. SMI technology is expected to be applied as an alternative to CEUS in the clinical follow-up of ablation lesions.

Validation of cervical lesion proportion measure using a gridded imaging techique to assess cervical pathology in women with genital schistosomiasis

Female genital schistosomiasis (FGS) is characterized by a pattern of lesions which manifest at the cervix and the vagina, such as homogeneous and grainy sandy patches, rubbery papules in addition to neovascularization. A tool for quantification of the lesions is needed to improve FGS research and control programs. Hitherto, no tools are available to quantify clinical pathology at the cervix in a standardized and reproducible manner. This study aimed to develop and validate a cervical lesion proportion (CLP) measure for quantification of cervical pathology in FGS. A digital imaging technique was applied in which a grid containing 424 identical squares was positioned on high resolution digital images from the cervix of 70 women with FGS. A CLP was made for each image by counting the total number of squares containing at least one type of pathognomonic lesions. For validation of inter- and intra-observer reliability, three different observers estimated CLP independently. In addition, a rubbery papule count (RPC) was determined in a similar manner. The intraclass correlation coefficient was 0.94 (excellent) for the CLP inter-rater reliability and 0.90 (good) for intra-rater reliability and the coefficients for the RPC were 0.88 and 0.80 (good), respectively. The CLP facilitated a reliable and reproducible quantification of the surface of the cervix affected by FGS pathognomonic lesions. Grading of cervical pathology by CLP can provide insight into the natural course of schistosome egg-induced pathology of the cervix. Moreover, CLP provides a measure for the efficacy of treatment.

Inter- and Intra-observer Reliability of the “assessment of Motor Repertoire- 3 to 5 Months” Based on Video Recordings of Infants With PWS

BackgroundThe “Assessment of Motor Repertoire - 3 to 5 Months”, which is part of Prechtl's General Movement Assessment (GMA), has been gradually applied to infants with genetic metabolic disorders. However, there still have been no studies on the application of GMA for infants with Prader-Williams Syndrome (PWS).Aimsthe purpose of this study was to determine inter- and intra-observer reliability of the assessment tool in PWS population.Study designReliability and agreement study.SubjectsThis was a cross-sectional study of 15 infants with PWS born at average gestational age 38 weeks.Outcome measuresStandardized video recordings of 15 infants with PWS (corrected ages 3 to 5 months) were independently assessed by three observers. Kappa and ICC statistics were applied in inter- and intra-observer reliability analysis.ResultsThe overall reliability ICCs values of “Motor Optimality Score” (MOS) ranged from 0.84 to 0.98 and the regarding pairwise agreement ranged between 0.86 and 0.95 in inter- observe reliability. In addition, ICC values for MOS ranged between 0.95 and 0.98 for respectively testers agreement in intra-observer reliability.The complete agreement reliability (100%) was achieved in subcategories of “Fidgety Movements” and “Movement Character” for the inter- and intra-observer. Moderate to high inter- and intra-observer reliability were found in subcategories of “Repertoire of Co-Existent Other Movements”, “Quality of Other Movements” and “Posture”, with kappa values ranging between 0.63 and 1.00. Conclusionhere were high levels of inter-and intra-observer agreement in the “Assessment of Motor Repertoire - 3 to 5 Months” for infants with PWS. It will be possible to carry out standardized quantitative assessment on the motor performance infants with PWS.