Auswahl der wissenschaftlichen Literatur zum Thema „Erect radiographic examinations“

Objectives: Pelvis radiographs are usually acquired supine despite standing imaging reflecting functional anatomy. We compared supine and erect radiographic examinations for anatomical features, radiation dose and image quality. Methods: 60 patients underwent pelvis radiography in both supine and erect positions at the same examination appointment. Measures of body mass index and sagittal diameter were obtained. Images were evaluated using visual grading analysis and pelvic tilt was compared. Dose–area product values were recorded and inputted into the CalDose_X software to estimate effective dose (ED). The CalDose_X software allowed comparisons using data from the erect and supine sex-specific phantoms (MAX06 & FAX06). Results: Patient sagittal diameter was greater on standing with an average 20.6% increase at the iliac crest (median 30.0, interquartile range [26.0 to 34.0] cm), in comparison to the supine position [24.0 (22.3 to 28.0) cm; p < 0.001]. 57 (95%) patients had posterior pelvic tilt on weight-bearing. Erect image quality was significantly decreased with median image quality scores of 78% (69 to 85) compared to 87% for the supine position [81 to 91] (p < 0.001). In the erect position, the ED was 47% higher [0.17 (0.13 to 0.33) mSv vs 0.12 (0.08 to 0.18) mSv (p < 0.001)], influenced by the increased sagittal diameter. 42 (70%) patients preferred the standing examination. Conclusion: Patient diameter and pelvic tilt were altered on weightbearing. Erect images demonstrated an overall decrease in image quality with a higher radiation dose. Optimal acquisition parameters are required for erect pelvis radiography as the supine technique is not directly transferable.

INTRODUCTION It has been suggested that changes to the training schemes of junior doctors and the increased pressure on emergency departments to manage their patients within a limited time might increase the number of unnecessary investigations performed on emergency admission patients. This, in turn, may lead to an increased number of investigations with normal results. In this study we try to analyse the role of the chest X-ray (CXR) as a diagnostic tool in patients presenting with acute abdominal pain. PATIENTS AND METHODS A retrospective study was performed of the request forms and results of all chest radiography performed on patients admitted on the emergency surgical intake with acute abdominal pain through utilisation of the prospec-tively maintained electronic radiology database. The indications were compared to the guidelines published by the Royal College of Radiologists (RCR) which have been adopted as the standard of care. RESULTS A total of 334 chest X-rays were identified of which only 23 (7%) had new findings. Four (1%) patients had free gas under the diaphragm. Of the CXRs, 258 (77%) were reported normal whilst 53 (16%) had old changes which were described in their hospital records and previous radiographs. Of the CXRs with new findings, only 20 were clinically significant and, of these, four (1%) were surgically significant. CONCLUSIONS The majority of CXRs performed on emergency surgical admissions with abdominal pain are unnecessary. By obtaining a clear history, performing a thorough clinical examination and following the RCR guidelines most of the CXRs could be avoided. This would lead to less radiation exposure, reduce delays to diagnosis, and provide significant financial savings.

Treatments of fragmentary fractures in case of loss regenerative potential of bone tissue require usingdiff erent composite materials. Among all of them, ceramics based on synthetic hydroxyapatite and tricalcium phosphate are considered promising. The reparative osteogenesis in spongy and compact rabbit’s bone tissueusing 3 composite materials with diff erent physicochemical propertieswas studied. A reparative osteogenesiscontrolled by monitoring clinical, radiologic and macromorphologic parameters. Composite materials infl uence on the organism was studied by determining the dynamics of hematological parameters throughout the study period. To realize this scheme was formed a 3 experimental groups and one control group of rabbits. The created defects of animals of fi rst experimental group were fi lled out with GT + α-TKF-500, thedefects of second oneanimals group fi lled out with GTlKl-2, and defects ofthird oneanimals group fi lled out with GTlKg-700. The GTlKl-700materials were doped with silicon. In control animals, bone defects were allowed to heal under a blood clot. During the studies, all animals were located in the same environment conditions. A blood samples for hematological investigation was taken from the external jugular vein before anesthesia and at the 3rd, 7th, 14th, 21st and 42nd day after surgery. X-ray examination was performed on 14th, 21st, and 42nddays.The animals were removed from the experiment on 21stand 42nd days. The samples were examined by macromorphologic method. By radiologic examination was found that composite materials had osteoconductive properties except the silicondoped example which hadosteoinductive properties. The samples of compact bone tissue of 1st and 3rd experimental groups characterized by formation of punctate osteosclerosis with a compacted contour of the periosteumon the 42nd day. But the bone samples of 2nd experimental group had compacted contours of the periosteum only. However, in the cancellous bone tissue on the 42nd day in the animals of the 1st experimental group developed point osteosclerosis, which visualized as individual granules of the composite.But in the animals of 2nd group thewhite spot which was outlined shape and homogeneous structure at the defect was found. The bone samples of 3rd animals group shoved a clearly limited point osteosclerosisforming were was found ceramic granules. In case using ofGT + α-TKF-500, a strong connection of granules from the formed bone tissue and without any periosteal growthswas noted. Using GTlKl-2 places of defects were identical to not injured sites of radial bones. Using GTlKg-700 shows that bone defect is fi lled to the level of the plane of the bone surface and covered with a periosteum without visible growths. The granules of the composite are evenly distributed in the regenerate and associated with bone tissue. The analysis of hematological parameters did not reveal any fundamental diff erences, but the use of hydroxyapatite implants is not accompanied, in contrast to spontaneous reparative osteogenesis, the development of leukocytosis, which indicates a moderate course of its infl ammatory reaction. But the latter is accompanied by a platelet reaction, the most pronounced when using implants, which is probably due to the infl uence of platelet factors and is indirect evidence of early osteoblastic reaction. Key words: fractures, rabbits, erythrocytes, leukocytes, platelets, hemoglobin.

A radiologic investigation was performed in 26 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. The reservoir and its efferent leg was best demonstrated by contrast enema. The size and position of the reservoir and the efferent leg was demonstrated, and stenoses, abscesses and fistulae could be identified. Examination of the small bowel with a contrast medium showed slight dilatation of the ileum orally to the reservoir in all instances and one patient had a stenosis at the junction of the afferent leg of the reservoir. Erect and supine projections of the abdomen showed gas in the intestine and fluid levels in the reservoir. These radiographic findings should not be confused with ileus or pelvic abscess. Radiology was of great value in disclosing postoperative complications. References

Rectal foreign bodies represent a unique and challenging field of surgical management which includes a careful history, physical examination and a high index of suspicion for complications. Foreign bodies are rarely seen in lower GI or rectum, inserted either accidently or for sexual satisfaction or to inflict harm. We have 3 case scenarios of unusual foreign body in rectum with varied clinical presentation, findings and three different methods of management/extraction done in our Institution. Patients present with common complaints of rectal or abdominal pain, constipation or obstipation, bright red blood per rectum, or incontinence. Initial step is to assess for peritonitis which is suggestive a perforation with intraperitoneal contamination and requires emergency exploratory. Erect Xray abdomen can reveal the presence of free air and the location of the object relative to the pelvic floor. A careful digital rectal examination is the most informative component of the evaluation process. Impacted foreign bodies may result in complications like intestinal obstruction, perforation of gut and peritonitis. Rectal foreign body is a diagnostic and management dilemma due to the delayed presentation owing to associated social stigma. Patients require a detailed examination and radiographic evaluation with resuscitation. Surgical intervention should be planned based on hemodynamic stability and presence/absence of perforation. Patient has to be referred to the psychiatrist for his perversion disorder, which is also mandatory for preventing recurrences.

Primary small bowel bezoars are rare and cause acute abdomen due to small bowel obstruction (SBO). A 69-year-old Japanese man presented with epigastric pain associated with fullness. Physical examination of the abdomen showed no marked signs of peritoneal irritation. An erect X-ray film of the abdomen showed small bowel obstruction. Computed tomography (CT) showed a dilated small bowel loop proximal to the site of the obstruction. Retrograde double balloon enteroscopy (DBE) was performed and showed yellow, hard bezoars blocking the distal ileum. At surgery, a bezoar was found impacted in the distal ileum, and enterotomy with extraction was performed. After 9 days, the patient was discharged from our hospital in satisfactory condition. DBE also appears to be a safe and useful diagnostic tool in patients with SBO, and the findings of DBE influence the strategy of therapy in patients in whom the cause of SBO could not be determined by conventional radiography.

Background: The objective of the study was to determine the outcome of secondary peritonitis in non-traumatic small and large bowel perforation in a secondary care hospital in the region of Ha’il, Kingdom of Saudi Arabia (KSA).Methods: This prospective study was conducted in a surgical unit of King Khalid Hospital, Ha’il Kingdom of Saudi Arabia, from 01 October 2013 to 30th June 2014. 30 patients were admitted through emergency room (ER). Every patient was enquired a detailed history about abdominal distension, abdominal pain, fever, constipation, vomiting, and gut motility. Clinical examination of the patient was done. Baseline investigations along with chest radiograph posterio-anterior (PA) view, abdominal radiograph with erect and supine views and ultrasound whole abdomen were included. All patients landed in the ER with peritonitis due to gastrointestinal perforation, regardless of their sex and age, were included. Peritonitis of primary cause or due to trauma, corrosive ingestion and anastomosis leak were excluded. Follow up of all the patients was done. Data was analyzed through SPSS software 16.Results: Out of 30 patients, 23 (76.66%) were male and 7 (23.33%) were female. Mean age 36.28±2.3 years. 80% presented with abdominal pain. Pneumoperitoneum on chest X-Ray was found in 21 (70%) patients. Duodenal perforation was the most common reason of peritonitis in 14 patients (46.66%). Surgical site wound infection is the commonest complication in 16 patients (53.33%).Conclusions: In conclusion, the outcome of secondary peritonitis in our Eastern population is perforation of the upper gastrointestinal tract and small bowel as the documented common cause, and wound infection as the commonest complication.

The results of the dynamics of the morphological parameters of the blood of a rabbit with model defects of the opening of the spongy and compact bone tissue at diff erent periods of reparative osteogenesis are presented. Formed 4 groups of rabbits. Bone lesions in the fi rst experimental group were fi lled with injectable platelet-rich fi brin, in the second - platelet-rich fi brin, in the third - a combination of platelet-rich fi brin, and hydroxyapatite with β-tricalcium phosphate.In the control group, the defects remained healed under a blood clot. All animals were in the same conditions of feeding and keeping, had unlimited access to water. During the study, rabbits were clinically observed. Blood was taken for morphological examination before surgery and on the 3rd, 7th, 14th, 21st, 42nd day. Animals were taken from the experiment on the 14th, 21st and 42nd days, an X-ray examination was carried out, bone tissue samples were taken. It was established that trauma of bone tissue leads to a number of reactions of the body aimed at restoring the damaged area. Against the background of the general picture of the obtained morphological results, the level of platelets signifi cantly changes compared to the physiological norm, while the number of red blood cells and white blood cells does not go beyond it. There is a slight increase in hemoglobin levels, especially in the experimental groups on the twenty-fi rst and forty-second day. Signifi cant changes in the number of red blood cells, white blood cells, platelets and hemoglobin concentration in the experimental groups were noted compared with the control group at diff erent periods of reparative osteogenesis.The use of various types of platelet concentrates aff ects the overall reaction of the body. On radiographs of the radial bones (compact bone tissue) on the twenty-fi rst day in the second and third experimental groups, where fi brin enriched with platelets and its combination with hydroxyapatite materials with β-tricalcium phosphate were used to replace bone defects, the infl ammatory reaction was manifested to a lesser extent. There was no signifi cant formation of bone callus compared with the fi rst, in which model defects were fi lled with injectable platelet-rich fi brin and the control group. Each of the types of platelet concentrates and their combination with hydroxyapatite ceramics have a diff erent eff ect on the restoration of bone defects and is accompanied by the appearance of a number of reactions, both local and general. According to the degree of intensity of this process, they can be placed in the following sequence: i-PRF ˂ PRF ˂ PRF+GT. Macromorphologically and radiologically signifi cant diff erences were not detected for diff erent types of bone tissue due to the use of each of the substances that concentrates platelets. The combination of hydroxyapatite granules with β-tricalcium phosphate and platelet-rich fi brin proved to be the best option for repairing the damaged area. Its use provides a signifi cantly smaller manifestation of the local infl ammatory reaction and causes the formation of optimal bone marrow. Key words: PRF, i-PRF, granules, centrifuges, growth factors, bone marrow.

Rectal foreign bodies represent a unique and challenging field of surgical management which includes a careful history, physical examination and a high index of suspicion for complications. Foreign bodies are rarely seen in lower GI or rectum, inserted either accidently or for sexual satisfaction or to inflict harm. We have 3 case scenarios of unusual foreign body in rectum with varied clinical presentation, findings and three different methods of management/extraction done in our Institution. Patients present with common complaints of rectal or abdominal pain, constipation or obstipation, bright red blood per rectum, or incontinence. Initial step is to assess for peritonitis which is suggestive a perforation with intraperitoneal contamination and requires emergency exploratory. Erect Xray abdomen can reveal the presence of free air and the location of the object relative to the pelvic floor. A careful digital rectal examination is the most informative component of the evaluation process. Impacted foreign bodies may result in complications like intestinal obstruction, perforation of gut and peritonitis. Rectal foreign body is a diagnostic and management dilemma due to the delayed presentation owing to associated social stigma. Patients require a detailed examination and radiographic evaluation with resuscitation. Surgical intervention should be planned based on hemodynamic stability and presence/absence of perforation. Patient has to be referred to the psychiatrist for his perversion disorder, which is also mandatory for preventing recurrences.

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Objectives: Pelvis radiographs are usually acquired supine despite standing imaging reflecting functional anatomy. We compared supine and erect radiographic examinations for anatomical features, radiation dose and image quality. Methods: 60 patients underwent pelvis radiography in both supine and erect positions at the same examination appointment. Measures of body mass index and sagittal diameter were obtained. Images were evaluated using visual grading analysis and pelvic tilt was compared. Dose–area product values were recorded and inputted into the CalDose_X software to estimate effective dose (ED). The CalDose_X software allowed comparisons using data from the erect and supine sex-specific phantoms (MAX06 & FAX06). Results: Patient sagittal diameter was greater on standing with an average 20.6% increase at the iliac crest (median 30.0, interquartile range [26.0 to 34.0] cm), in comparison to the supine position [24.0 (22.3 to 28.0) cm; p < 0.001]. 57 (95%) patients had posterior pelvic tilt on weight-bearing. Erect image quality was significantly decreased with median image quality scores of 78% (69 to 85) compared to 87% for the supine position [81 to 91] (p < 0.001). In the erect position, the ED was 47% higher [0.17 (0.13 to 0.33) mSv vs 0.12 (0.08 to 0.18) mSv (p < 0.001)], influenced by the increased sagittal diameter. 42 (70%) patients preferred the standing examination. Conclusion: Patient diameter and pelvic tilt were altered on weightbearing. Erect images demonstrated an overall decrease in image quality with a higher radiation dose. Optimal acquisition parameters are required for erect pelvis radiography as the supine technique is not directly transferable.
College of Radiographers Industry Partnership Scheme grant.