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Kumar, A., W. W. Chau, A. L. H. Hung, J. K. T. Wong, B. K. W. Ng, and J. C. Y. Cheng. "Gonadal shield: is it the Albatross hanging around the neck of developmental dysplasia of the hip research?" Journal of Children's Orthopaedics 12, no. 6 (December 2018): 606–13. http://dx.doi.org/10.1302/1863-2548.12.180133.
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Purpose Prospective randomized controlled trials and long-term studies are essential future directions for building evidence-based practices in developmental dysplasia of the hip (DDH), however, sufficient attrition in data (> 20%) can introduce bias deteriorating research quality. Pelvic radiography is synonymous with DDH assessment and so are Gonadal Shield (GS) recommendations with pelvic radiography. Nonetheless, losses to diagnostic information and inadequate protection have been increasingly implicated to GS usage, with significantly worse implications in female patients. Understandably for DDH, a disease with 80% female prevalence, the impact of GS usage on quality of radiographs and readability of radiological data may be drastic. This study aims to objectively define the implications of GS recommendations in DDH patients. Methods Pelvis radiographs of all DDH patients under the hip surveillance programme at a tertiary care hospital with a written protocol for GS usage were evaluated. Images were reviewed for gender, GS presence, adequate gonadal protection and obstruction of essential anatomical landmarks for pelvic indices. Results In all, 131 pelvis radiographs with DDH diagnoses (age: 1.25 to 6 years; 107 female, 24 male pelvises) were reviewed. Only 42.67% (56) of pelvis radiographs used GS despite the presence of a clear protocol. Useful anatomical landmarks were obstructed in 58.9% of radiographs with GS present. Lost diagnostic information was more common in female patients than male patients (68.1% versus 11.1%, p < 0.01). GS was ineffective at gonadal protection in 73.2% (41) of the pelvises with worse protection in female patients (78.7% vs 44.4%; p = 0.03). Conclusions Ironically, essential anatomy was obstructed in all the adequately protected female pelvises. Routine GS usage results in substantial attrition of radiographic data in DDH patients. Level of Evidence III
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Li, Ryan T., Raymond W. Liu, Mithun Neral, Heath Gould, Emily Hu, Shane Nho, and Michael J. Salata. "Use of the False-Profile Radiographic View to Measure Pelvic Incidence." American Journal of Sports Medicine 46, no. 9 (July 2018): 2089–95. http://dx.doi.org/10.1177/0363546518780938.
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Background: Pelvic incidence (PI) is an important variable in assessing spinopelvic balance that is associated with hip pathology. A lateral radiograph of the pelvis can be used to measure PI, but this view is not routinely performed in the clinical setting during evaluation of hip pain. The false-profile (FP) radiographic view of the hip is commonly obtained to measure acetabular coverage. Purpose: To evaluate the tolerance of PI measurements to pelvic rotation and assess the feasibility of using an FP radiograph to obtain an accurate measurement of PI. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A mathematical model was developed to predict the change in PI with rotation. Fluoroscopic images were obtained of 6 reconstructed cadaveric adult pelvis and femur specimens at varying degrees of rotation, including a perfect lateral and FP image. PI was measured with the midpoint between the centers of the femoral heads as a reference point. The findings were confirmed clinically by retrospectively reviewing FP radiographs and computed tomography (CT) scans of 40 clinical patients. PI was measured on FP radiographs and CT scans by 2 independent reviewers. Results: With dry cadaveric pelvis specimens, the discrepancy in PI measured between fluoroscopic FP and lateral views was 1.6° (95% CI, 0.7°-2.4°). There was excellent agreement between CT and FP radiographs with regard to measurement of PI (intraclass correlation coefficient = 0.92; 95% CI, 0.78-0.98). Mean discrepancy in PI measured between the 40 clinical FP radiographs and CT scans was 2.8° (range, 0.1°-9.1°). Conclusion: Increased rotation from a lateral view results in greater error in measuring PI, although relatively nominally with a 2.8° error with the 25° of rotation in clinical true FP views. These data demonstrate that FP radiographs can be used to measure PI with reasonable accuracy.
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Misiura, Anne K., Autumn D. Nanassy, and Jacqueline Urbine. "Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?" International Journal of Pediatrics 2018 (October 2, 2018): 1–4. http://dx.doi.org/10.1155/2018/6260954.
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Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.
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Spiker, Andrea M., Ryan M. Graf, Sean P. Duminie, Stephanie A. Kliethermes, and David C. Goodspeed. "DIFFERENCES IN RADIOGRAPHIC MEASUREMENTS ON STANDING VERSUS SUPINE PELVIC RADIOGRAPHS." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0016. http://dx.doi.org/10.1177/2325967120s00167.
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Background: Accurate pelvic radiographic measurements is of clear clinical importance, as these measurements can drive the indications for surgery, the surgical approach utilized, and/or the degree of correction during hip preservation surgery. Currently, there are a large number of measurements available and reported on the literature when referencing anterior-posterior (AP) pelvic radiographs. However, there is no standardization of whether these pelvic radiographs are obtained in the standing or supine position. Hypothesis/Purpose: Standing vs. Supine radiographs, obtained in the same patient, will result in different value for standard radiographic measurements used in making hip pathology diagnoses. Methods: All new patients who presented for evaluation of hip pain between September 2016 and July 2018 were retrospectively reviewed. Inclusion criteria included age 18-50, no prior hip surgery/injury, and both standing and supine AP pelvis radiographs dated within 2 years of each other. Measurements were obtained on 26 radiographs (52 hips), blinded to patient demographics and standing versus supine radiograph. Measurements included minimum joint space, lateral center edge angle (LCEA), acetabular depth, acetabular inclination, Tönnis Grade, crossover sign, posterior wall sign, ischial spine sign. Results: Standing films resulted in significantly lower LCEA and acetabular depth measurements, and higher acetabular inclination. Supine measurements for crossover sign were 5.69 times more likely to be positive than standing measurements. Similarly, supine measurements for ischial spine were 7.93 times more likely to be positive (see Table 1). Conclusion: Based on our study, supine films are almost 6 times more likely to give a positive crossover sign and almost 8 times more likely to give a positive ischial spine sign than a standing film in the same patient. Additionally, LCEA, acetabular depth will be lower and acetabular inclination will be higher on standing films. As such, our recommendation is to obtain standing AP pelvis radiographs to obtain the most accurate pelvic radiographic measurements in hip preservation patients. Tables: [Table: see text]
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Derbyshire, Brian. "Correction of radiographic measurements of acetabular cup wear for variations in pelvis orientation." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 232, no. 3 (February 23, 2018): 299–309. http://dx.doi.org/10.1177/0954411918754924.
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Radiographic measurement of two-dimensional acetabular cup wear is usually carried out on a series of follow-up radiographs of the patient’s pelvis. Since the orientation of the pelvis might not be consistent at every X-ray examination, the resulting change in view of the wear plane introduces error into the linear wear measurement. This effect is amplified on some designs of cup in which the centre of the socket is several millimetres below the centre of the cup or circular wire marker. This study describes the formulation of a mathematical method to correct radiographic wear measurements for changes in pelvis orientation. A mathematical simulation of changes in cup orientation and wear vectors caused by pelvic tilt was used to confirm that the formulae corrected the wear exactly if the radiographic plane of the reference radiograph was parallel to the true plane of wear. An error analysis showed that even when the true wear plane was not parallel to the reference radiographic plane, the formulae could still provide a useful correction. A published correction formula was found to be ineffective.
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Boënnec, Ronan, Paul-Armand Dujardin, Benjamin Meunier, Jean-Michel Rafin, Dominique Sirinelli, Laurent Brunereau, and Baptiste Morel. "REDUCING PELVIS RADIOGRAPH EXPOSURE IN CHILDREN USING A DOSE SIMULATION X-RAY RESEARCH SOFTWARE." Radiation Protection Dosimetry 194, no. 2-3 (May 2021): 90–96. http://dx.doi.org/10.1093/rpd/ncab083.
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Abstract Pelvis radiography is a frequent X-ray examination. The objective of our study was to determine the minimum dose to be delivered without reducing the quality. We included 60 children having a pelvis X-ray in four groups that were equally represented by weight ranges. A software simulated, for each radiograph, six additional simulated photonic noise images corresponding to 100, 80, 64, 50, 40 and 32% of the initial dose. The 360 radiographs were blindly scored by two radiologists using a semi-quantitative Likert scale. There was no significant difference in scoring between the reference radiograph and simulated radiographs at 80% of the dose in children between 0 and 15 kg and over 35 kg. Inter-observer reproducibility was moderate to very good. Pelvis X-ray doses might be reduced by 20% in children in our institution. Software that produces simulated X-ray with decreasing dose might be a useful tool for an optimization process.
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Csébi, Péter, Alexander Tichy, Michaela Gumpenberger, and Eberhard Ludewig. "The slope of the pelvis is variable in dogs but does not show correlation with femoral subluxation." Acta Veterinaria Hungarica 68, no. 2 (October 13, 2020): 207–11. http://dx.doi.org/10.1556/004.2020.00020.
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AbstractThe aim of this study was to investigate the variability of the slope of the pelvis in different dog breeds and the correlation between pelvic slope and femoral subluxation. The sacrum–pelvis angle (SPA), the angulation between the sacrum and the axis of the ilium was created to represent the differences in the slope of the pelvis on lateral pelvic radiographs. The Norberg angle (NA) was used to quantify the femoral subluxation on hip-extended radiographs. Archived standard ventrodorsal hip radiographs and lateral lumbosacral radiographs of the same dogs were retrieved and a single observer measured the SPA and the NA in each case. A total of 180 dogs from six different breeds were sampled. The SPA varied between 40° and 71.5° and the NA between 71.2° and 113.9°. The findings indicated that there are significant individual and interbreed variations in the slope of the pelvis. However, no significant relationship between the slope of the pelvis and femoral subluxation could be identified.
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Abola, Matthew V., Derrick M. Knapik, Daniel R. Cooperman, and Raymond W. Liu. "Correlation between the distance from the pubic symphysis to the sacrum with pelvic incidence." HIP International 29, no. 5 (May 20, 2019): 564–67. http://dx.doi.org/10.1177/1120700019850776.
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Introduction: The distance between the pubic symphysis and sacrococcygeal joint has been noted as an important parameter in evaluating pelvic tilt in an anteroposterior (AP) radiograph. Similarly, pelvic incidence measures the sagittal balance of the pelvis and is influenced by pelvic rotation. The relationship between these 2 parameters is unknown and could affect interpretation of pelvic AP radiographs. Methods: We reconstructed 248 cadaveric pelvises. Pelvic incidence was measured using a previously validated method. Pubic symphysis-sacrococcygeal joint (PSS) height was measured from the superior pubic tubercle to the sacrococcygeal joint. The pelvises were positioned so that the anterior pelvis lay flush with the surface. A ruler was zeroed on the pubic tubercles and a transverse projecting laser was used to measure the height to the sacrococcygeal joint. Results: A total of 248 pelvises were reconstructed. Average age of death of the specimens was 33±6.0 years. 80% of the pelvises were male, 56% were Caucasian, and 44% African American. The mean PSS height was 2.2 ± 1.4 cm and mean PI was 44.3° ± 10.6°. Multiple regression analysis found PI and PSS height were not correlated ( p = 0.144). Females had a larger PSS height than males (beta = 1.17, p < 0.001) and African Americans a larger PSS height than Caucasians (beta = 0.63, p < 0.001). Conclusions: This study provides useful information for clinicians in evaluating AP radiographs of the pelvis in that it supports the use of PSS height to judge the adequacy of a radiograph even in the context of abnormal pelvic incidence.
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Senthirajah, S. K. J., S. Nemanic, W. Baltzer, J. Warnock, G. Bobe, and S. M. Stieger-Vanegas. "Evaluation of the diagnostic accuracy of four-view radiography and conventional computed tomography analysing sacral and pelvic fractures in dogs." Veterinary and Comparative Orthopaedics and Traumatology 28, no. 03 (2015): 155–63. http://dx.doi.org/10.3415/vcot-14-06-0096.
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SummaryObjective: The purpose of our study was (1) to determine whether four-view radiography of the pelvis is as reliable and accurate as computed tomography (CT) in diagnosing sacral and pelvic fractures, in addition to coxofemoral and sacroiliac joint subluxation or luxation, and (2) to evaluate the effect of the amount of training in reading diagnostic imaging studies on the accuracy of diagnosing sacral and pelvic fractures in dogs.Methods: Sacral and pelvic fractures were created in 11 canine cadavers using a lateral impactor. In all cadavers, frog-legged ventrodorsal, lateral, right and left ventro-45°-medial to dorsolateral oblique frog leg (“rollover 45-degree view”) radiographs and a CT of the pelvis were obtained. Two radiologists, two surgeons and two veterinary students classified fractures using a confidence scale and noted the duration of evaluation for each imaging modality and case. The imaging results were compared to gross dissection.Results: All evaluators required significantly more time to analyse CT images compared to radiographic images. Sacral and pelvic fractures, specifically those of the sacral body, ischiatic table, and the pubic bone, were more accurately diagnosed using CT compared to radiography. Fractures of the acetabulum and iliac body were diagnosed with similar accuracy (at least 86%) using either modality.Clinical significance: Computed tomography is a better method for detecting canine sacral and some pelvic fractures compared to radiography. Computed tomography provided an accuracy of close to 100% in persons trained in evaluating CT images.
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Flintham, Kevin, Kholoud Alzyoud, Andrew England, Peter Hogg, and Beverly Snaith. "Comparing the supine and erect pelvis radiographic examinations: an evaluation of anatomy, image quality and radiation dose." British Journal of Radiology 94, no. 1123 (July 1, 2021): 20210047. http://dx.doi.org/10.1259/bjr.20210047.
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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.
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Peck, Jeffrey, Armando Villamil, Kara Fiore, Cheryl Tano, and Jessica Leasure. "Inter- and intra-observer variability of radiography and computed tomography for evaluation of Zurich cementless acetabular cup placement ex vivo." Veterinary and Comparative Orthopaedics and Traumatology 29, no. 06 (November 2016): 507–14. http://dx.doi.org/10.3415/vcot-16-05-0068.
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SummaryObjective: To evaluate the inter- and intra-observer variability in measurement of the angle of lateral opening (ALO) and version angle measurement using digital radiography and computed tomography (CT).Methods: Each hemipelvis was implanted with a cementless acetabular cup. Ventrodorsal and mediolateral radiographs were made of each pelvis, followed by CT imaging. After removal of the first cup, the pelves were implanted with an acetabular cup in the contra-lateral acetabulum and imaging was repeated. Three surgeons measured the ALO and version angles three times for each cup from the mediolateral radiographic projection. The same measurements were made using three-dimensional multiplanar reconstructions from CT images. Two anatomical axes were used to measure pelvic inclination in the sagittal plane, resulting in six measurements per cup. Two-way repeated measures analysis of variance evaluated inter- and intra-observer repeatability for radiographic and CT-based measurements.Results: Version angle based on radio-graphic measurement did not differ within surgeons (p = 0.433), but differed between surgeons (p <0.001). Radiographic measurement of ALO differed within surgeons (p = 0.006) but not between surgeons (p = 0.989). The ALO and version angle measured on CT images did not differ with or between surgeons.Clinical significance: Assessment of inter-and intra-observer measurement of ALO and version angle was more reproducible using CT images than conventional mediolateral radiography for a Zurich cementless acetabular cup.
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Yaprakci, Mustafa Volkan, Marek Galanty, and Katarzyna Siewruk. "Clinical Comparative Evaluation of the V-Cut Pelvic Ostectomy in the Management of Canine Hip Dysplasia." Bulletin of the Veterinary Institute in Pulawy 57, no. 2 (June 1, 2013): 243–47. http://dx.doi.org/10.2478/bvip-2013-0043.
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Abstract The operational method (V-cut pelvic ostectomy) was applied on seven dogs. Pubic symphysis was cut in an inverted “V” fashion and a bone gap occurred between pelvic halves. The gap was reduced by contracting both sides of the pelvis. A new pubic symphysis developed. Results were evaluated with radiographs and different clinical and orthopedic tests. Radiographic measures between mutual parts of pelvic bone showed a marked increase in Norberg angles and diminishing in Bardens, Barlow, and Ortolani orthopedic tests after operations. Principal conclusion: V-cut pelvic ostectomy was found to be a successful operation technique in treatment of canine hip dysplasia.
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Wu, Ching-Ho, Cheng-Chung Lin, Hsuan-Lun Lu, Tung-Wu Lu, and Lih-Seng Yeh. "EFFECTS OF PELVIC AND FEMORAL POSITIONING ON CANINE NORBERG ANGLE MEASUREMENTS AND TEST–RETEST RELIABILITY: A COMPUTED TOMOGRAPHY-BASED SIMULATION STUDY." Biomedical Engineering: Applications, Basis and Communications 26, no. 06 (December 2014): 1450076. http://dx.doi.org/10.4015/s1016237214500768.
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Canine hip dysplasia is a common disease in dogs, often diagnosed by using the Norberg angle (NA), an index for the laxity of the hip joint. Measurement of the NA can be affected by the pelvic and femoral positioning during imaging, the effects and test–retest reliability of which have not been documented. To bridge the gap in knowledge, computed tomography data from 11 Labrador Retriever dogs were obtained and used to generate synthetic ventrodorsal radiographs of the hip for NA measurements via a perspective projection model. Twenty-five synthetic radiographs of the hips were generated at positions defined by combinations of five pelvic tilt angles (-20° to 20° at 10° intervals) and five femoral elevation angles (from full extension to 40° at 10° intervals). For each radiograph, the NA was measured three times by each of the two experienced veterinarian examiners. It was found that both the increase in caudal pelvic tilt and femoral elevation increased the measured NA, although the intra- and inter-examiner reliability was very good for a given hip position. The current results suggest that careful positioning of the pelvis and femur during radiographic imaging is critical for accurately measuring the NA, and thus the laxity of the hip, for the clinical diagnosis of hip dysplasia.
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Ilchmann, T., U. Kesteris, and H. Wingstrand. "Effect of Pelvic Tilt on Radiographic Migration and Wear Measurements after Total Hip Arthroplasty." HIP International 8, no. 1 (January 1998): 16–23. http://dx.doi.org/10.1177/112070009800800102.
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Tilt effects on radiographic measurements after total hip arthroplasty should be studied. A new computerized method for measurement, called EBRA, making three-dimensional calculations and intended to identify tilted radiographs was evaluated for its clinical usefulness. In an experimental set-up repeated radiographs were taken with a human pelvis tilted gradually around its horizontal and vertical axes. Migration and wear were measured with the EBRA method and the results were compared with those made using standard methods. Tilted radiographs were identified and excluded from analysis by the EBRA method, significantly reducing the maximum error of measurement. A systematic error of measurement was found in the presence of consecutively changing tilt in a single direction. Wear measurements were only slightly affected by pelvic tilt. A pelvic tilt can cause considerable errors in the measurement of cup migration-i.e. up to 8.2 mm. The EBRA method improves the accuracy of measurements by taking the effects of tilt into account.
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Huysmans, T., R. Van Audekercke, J. Vander Sloten, H. Bruyninckx, and G. Van der Perre. "A three-dimensional active shape model for the detection of anatomical landmarks on the back surface." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 219, no. 2 (February 1, 2005): 129–42. http://dx.doi.org/10.1243/095441105x9309.
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In this study relations between anatomical landmarks on the dorsal surface of the human torso corresponding to underlying skeletal structures are established. By examining the statistics of the positions of the landmarks in a training set of subjects a point distribution model is derived. Rotations of the pelvis are simulated in order to show that the main mode shapes of variation are consistent with rotations of the pelvis relative to the trunk. The parameters of these mode shapes can therefore be used as independent measures of clinical parameters such as pelvic inclination, pelvic tilt, etc. The point distribution model is further applied to improve reliability and robustness for an automatic and objective detection of the anatomical landmarks on the back surface (active shape model). The results show that it is possible to replace radiographs by surface measurements in order to measure position and orientation of the pelvis, which is particularly valuable in the case of functional examinations that normally involve a large number of radiographs (e.g. to measure the position of the pelvis in a scoliosis).
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Delagrammaticas, Dimitri E., George Ochenjele, Brett D. Rosenthal, Benjamin Assenmacher, David W. Manning, and Michael D. Stover. "Intraoperative evaluation of acetabular cup position during anterior approach total hip arthroplasty: are we accurately interpreting?" HIP International 30, no. 1 (August 6, 2019): 40–47. http://dx.doi.org/10.1177/1120700019868665.
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Introduction: Intraoperative radiographic evaluation during total hip arthroplasty (THA) has shown to improve the accuracy of acetabular component placement, however, differences in interpretation based on radiographic technique has not been established. This study aims to determine if differences exist in the interpretation of acetabular component abduction and anteversion between different radiographic projections. Methods: 55 consecutive direct anterior THAs in 49 patients were prospectively enrolled. Target anteversion and abduction was defined by the Lewinnek zone. Fluoroscopy was used to direct acetabular component placement intraoperatively. After final cup implantation, fluoroscopic posterior-anterior hip and pelvis images were obtained for analysis. After completion of the procedure, an anterior-posterior plain pelvis radiograph was obtained in the operating room. Acetabulum component abduction and anteversion were postoperatively determined using specialised software on each of the 3 image acquisition methods. Results: Average acetabular cup abduction for intraoperative fluoroscopic posterior-anterior hip (FH), intraoperative fluoroscopic posterior-anterior pelvis (FP), and postoperative, standard, anteroposterior pelvis radiographs (PP) was 40.95° ± 2.87°, 38.87° ± 3.82° and 41.73° ± 2.96° respectively. The fluoroscopic hip and fluoroscopic pelvis tended to underestimate acetabular cup abduction compared to the postoperative pelvis ( p < 0.001). Average acetabular cup anteversion for FH, FP, and PP was 19.89° ± 4.87°, 24.38° ± 5.31° and 13.36° ± 3.52° respectively. Both the fluoroscopic hip and fluoroscopic pelvis overestimated anteversion compared to the AP pelvis, with a 6.38° greater mean value measurement for FH ( p < 0.001), and an 11° greater mean value measurement for FP ( p < 0.001). Conclusions: Fluoroscopic technique and differences between radiographic projections may result in discrepancies in component position interpretation. Our results support the use of the fluoroscopic posterior-anterior hip as the choice fluoroscopic imaging technique.
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Cachon, T., D. Fau, C. Carozzo, E. Viguier, F. Collard, D. Remy, and J. P. Genevois. "Canine hip dysplasia radiographic screening. Prevalence of rotation of the pelvis along its length axis in 7,012 conventional hip extended radiographs." Veterinary and Comparative Orthopaedics and Traumatology 20, no. 04 (2007): 296–98. http://dx.doi.org/10.1160/vcot-07-01-0007.
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SummaryThe prevalence of rotation of the pelvis along its length axis was noted, as was the number of rotations towards the right or left hand side of the dog, on 7,012 conventional hip extended radiographs, which were sent for official screening. 29.8% of the radiographs showed a rotation the pelvis. The rotation was statistically more frequent towards the left hand side of the dog. The number of rejected radiographs for too important pelvis rotation was only 5.2%. The consequences of the pelvis rotation on the Norberg-Olsson angle, on the dorsal femoral head coverage, and in the aspect of cranial acetabular edge have to be taken into account when scoring the dog for hip dysplasia.
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Stern, Christoph, Stefan Sommer, Christoph Germann, Julien Galley, Christian W. A. Pfirrmann, Benjamin Fritz, and Reto Sutter. "Pelvic bone CT: can tin-filtered ultra-low-dose CT and virtual radiographs be used as alternative for standard CT and digital radiographs?" European Radiology 31, no. 9 (March 12, 2021): 6793–801. http://dx.doi.org/10.1007/s00330-021-07824-x.
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Abstract Objectives To compare ultra-low-dose CT (ULD-CT) of the osseous pelvis with tin filtration to standard clinical CT (CT), and to assess the quality of computed virtual pelvic radiographs (VRs). Methods CT protocols were optimized in a phantom and three pelvic cadavers. Thirty prospectively included patients received both standard CT (automated tube voltage selection and current modulation) and tin-filtered ULD-CT of the pelvis (Sn140kV/50mAs). VRs of ULD-CT data were computed using an adapted cone beam–based projection algorithm and were compared to digital radiographs (DRs) of the pelvis. CT and DR dose parameters and quantitative and qualitative measures (1 = worst, 4 = best) were compared. CT and ULD-CT were assessed for osseous pathologies. Results Dose reduction of ULD-CT was 84% compared to CT, with a median effective dose of 0.38 mSv (quartile 1–3: 0.37–0.4 mSv) versus 2.31 mSv (1.82–3.58 mSv; p < .001), respectively. Mean dose of DR was 0.37 mSv (± 0.14 mSv). The median signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of bone were significantly higher for CT (64.3 and 21.5, respectively) compared to ULD-CT (50.4 and 18.8; p ≤ .01), while ULD-CT was significantly more dose efficient (figure of merit (FOM) 927.6) than CT (FOM 167.6; p < .001). Both CT and ULD-CT were of good image quality with excellent depiction of anatomy, with a median score of 4 (4–4) for both methods (p = .1). Agreement was perfect between both methods regarding the prevalence of assessed osseous pathologies (p > .99). VRs were successfully calculated and were equivalent to DRs. Conclusion Tin-filtered ULD-CT of the pelvis at a dose equivalent to standard radiographs is adequate for assessing bone anatomy and osseous pathologies and had a markedly superior dose efficiency than standard CT. Key Points • Ultra-low-dose pelvic CT with tin filtration (0.38 mSv) can be performed at a dose of digital radiographs (0.37 mSv), with a dose reduction of 84% compared to standard CT (2.31 mSv). • Tin-filtered ultra-low-dose CT had lower SNR and CNR and higher image noise than standard CT, but showed clear depiction of anatomy and accurate detection of osseous pathologies. • Virtual pelvic radiographs were successfully calculated from ultra-low-dose CT data and were equivalent to digital radiographs.
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Kaser-Hotz, B., M. Hässig, K. Voss, P. M. Montavon, and D. Zulauf. "Radiographic examination and outcome in consecutive feline trauma patients." Veterinary and Comparative Orthopaedics and Traumatology 21, no. 01 (2008): 36–40. http://dx.doi.org/10.3415/vcot-07-01-0012.
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SummaryUsing univariate analysis, the correlation between signalment, history, outcome and radiographic diagnosis made on whole-body radiographs was investigated in 100 consecutive feline trauma patients of an urban clinic. The radiographic findings included: 53 thoracic injuries, 39 abdominal injuries, 34 pelvic injuries, 28 soft tissue injuries, 26 spinal injuries, and 19 cases with signs of hypovolemia. Only four radiographs were considered normal. Surgical intervention was carried out in 51 cases. Of the 100 cases, 73 survived, 23 were euthanatized, and four died. A significant positive correlation with euthanasia was found when compared to patient age (p=0.0059), abdominal trauma (P=0.0500), spinal fractures (P=0.0468), and soft tissue injuries (P=0.0175). A significant negative correlation with survival was found when compared to patient age (P=0.0358), abdominal trauma (P=0.0439), intraperitoneal free air (P=0.0041), and soft tissue injury (P=0.0288). The results of this study indicate that whole-body radiographs are useful in detecting injury in the thorax, abdomen, spine, pelvis and soft tissues, and are valuable in the diagnostic work-up of feline trauma patients.
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Yun, Ho Hyun, William S. Murphy, Daniel M. Ward, Guoyan Zheng, Brett Hayden, and Stephen B. Murphy. "Effect of pelvic tilt and rotation on cup orientation in standing anteroposterior radiographs." HIP International 30, no. 1 (March 5, 2019): 48–55. http://dx.doi.org/10.1177/1120700019831665.
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Background: Individual pelvic tilt and rotation have wide variability that can affect the measurement of cup orientation in anteroposterior (AP) radiographs. The purpose of this study was to analyse the effect of pelvic tilt and rotation on radiographic measurements of cup orientation. Methods: A total of 53 patients (63 hips) were included in this study. The patients underwent a computed tomography study with standing AP pelvis radiographs taken both preoperatively and approximately 3 months postoperatively. We used 2-dimensional/3-dimensional matching to measure the pelvic tilt and rotation, and the non-standardised and standardised cup orientation. Results: There was no difference in the pelvic tilt and rotation between the preoperative and postoperative radiographs. The distribution of the differences between the non-standardised and standardised cup anteversion exhibited a change within 5° in only 34/63 (54%) hips. The pelvic tilt correlated with the difference between the non-standardised and standardised cup anteversion, but the pelvic rotation did not. When all 63 hips were separated into the right and left sides, the pelvic rotation inversely correlated with the pelvic tilt-adjusted difference between the non-standardised and standardised cup anteversion of the right side but directly correlated with that of the left side. Conclusions: The current study demonstrated that the measurement of cup anteversion in standing AP radiographs is significantly affected by both the pelvic tilt and pelvic rotation. An improved understanding of the pelvic orientation may eventually allow for desired cup positioning on a patient-specific basis to potentially reduce complications associated with the malposition of the cup.
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Boiocchi, S., L. Vezzoni, V. Bronzo, F. Rossi, and A. Vezzoni. "Radiographic changes of the pelvis in Labrador and Golden Retrievers after juvenile pubic symphysiodesis." Veterinary and Comparative Orthopaedics and Traumatology 26, no. 03 (2013): 218–25. http://dx.doi.org/10.3415/vcot-12-06-0074.
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SummaryObjectives: The hypothesis of this study was that juvenile pubic symphysiodesis (JPS) results in pelvic changes that can be identified radiographically in adult dogs.Methods: The medical records at the Clinica Veterinaria Vezzoni were searched for standard ventro-dorsal views of the pelvis of adult Labrador and Golden Retrievers that had undergone JPS or had not undergone surgery. The objective assessment of radiographs included the analysis of various pelvic measurements. Subjective evaluation of radiographs was undertaken by 18 specialists and 21 general practitioners and was based on five criteria relating to 1) the acetabular fossae, 2) the pubic symphysis, 3) the margin of the cranial pubic area, 4) the pubic rami, and 5) the obturator foramen.Results: The radiographs of 42 Labrador Retrievers and 16 Golden Retrievers were evaluated. The most useful criteria were the radiographic measurement of the shape of the obturator foramen and two different ratios of length to width of the pubic rami; these values were significantly smaller in dogs after JPS. The pelvic canal width was the same in both groups. All objective measurements were repeatable within and between evaluators. The most reliable subjective criterion was number 4, followed by number 5 in Golden Retrievers and by 2 in Labrador Retrievers.Conclusion: Our objective and subjective evaluations were simple and yielded useful and repeatable results. There was no significant difference between general practitioners and specialists with regard to subjective evaluation, which indicates that these evaluation criteria can be used by small animal clinicians after minimal training.
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Seyrek Intas, D., G. Yilmazbas, K. Seyrek Intas, A. Keskin, I. H. Kumru, M. Kramer, and N. Celimli. "Radiographic pelvimetry and evaluation of radiographic findings of the pelvis in cats with dystocia." Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere 36, no. 04 (2008): 277–84. http://dx.doi.org/10.1055/s-0038-1622688.
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Summary Objective: The aim of this study was to determine reference values for pelvic dimensions in radiographically unremarkable native Turkish cats (similar to European Shorthair cats) and to evaluate radiographic findings of the pelvis in cats with dystocia and to compare their pelvimetric measurements with those of radiographically unremarkable cats. Material and methods: Pelvimetry was performed on ventro-dorsal and lateral radiographs of radiographically unremarkable male (n = 34) and female cats (n = 23) with no history of dystocia and cats presented with dystocia. Cats with dystocia were classified in groups according to radiographical findings: cats without obvious radiographical changes, cats with traumatic pelvic stenosis and cats with pelvic narrowing due to metabolic disease. Statistical analyses were performed to find out significant differences between both groups with respect to gender and age. Results: Pelvic dimensions of radiographically unremarkable cats are greater in males compared to females. These differences increase with increasing age, but are not significant in cats older than 2 years. Twenty-five out of 37 queens presented with dystocia had significantly smaller pelvic dimensions compared to radiographically unremarkable queens. Deformation/narrowing of the pelvis in 12 cats (32%) due to old fractures and metabolic bone disease occurred in 7 and 5 cases, respectively. Conclusion: Old, untreated pelvic fractures and metabolic disorders may cause stenosis of the birth canal and dystocia. However, there is a high rate of queens without deformation, but smaller pelvic dimension experiencing dystocia. As 80% of these cats are around 1 year of age they might still be growing or are underdeveloped, despite pelvic physeal growth plates are already closed. Clinical relevance: Pelvic radiographs and pelvimetry before mating enables to identify cats with pelvic narrowing due to traumatic, metabolic, or developmental reasons and may prevent the queen from potential dystocia.
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DelSole, Edward M., and John J. Mercuri. "Utility of Upright Weight-bearing Imaging in Total Hip Arthroplasty." Seminars in Musculoskeletal Radiology 23, no. 06 (November 19, 2019): 603–8. http://dx.doi.org/10.1055/s-0039-1697935.
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AbstractPlanning for total hip arthroplasty (THA) has traditionally been performed using static supine anteroposterior radiographs of the pelvis. Recent advances in imaging technology and the understanding of human spinopelvic kinematics have made weight-bearing radiography an important adjunct to supine imaging. Hip surgeons can use weight-bearing imaging to optimize THA component position to prevent hip instability and early component wear. The goal of this narrative review is to delineate the fundamentals of spinopelvic kinematics, the benefits of surgical planning using weight-bearing radiography, and the underpinnings of upright full-body stereoradiography as a useful adjunct to traditional supine radiographs.
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O'Regan, Declan, Chris Harvey, and Steve Allen. "Interpretation of pelvis and hip radiographs." British Journal of Hospital Medicine 67, Sup6 (June 2006): M113—M115. http://dx.doi.org/10.12968/hmed.2006.67.sup6.21303.
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Janjua, M. Burhan, Jared C. Tishelman, Dennis Vasquez-Montes, Max Vaynrub, Thomas J. Errico, Aaron J. Buckland, and Themistocles Protopsaltis. "The value of sitting radiographs: analysis of spine flexibility and its utility in preoperative planning for adult spinal deformity surgery." Journal of Neurosurgery: Spine 29, no. 4 (October 2018): 414–21. http://dx.doi.org/10.3171/2018.2.spine17749.
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OBJECTIVEPreoperative planning of thoracolumbar deformity (TLD) surgery has been shown to improve radiographic and clinical outcomes. One of the confounders in attaining optimal postoperative alignment is the reciprocal hyperkyphosis of unfused thoracic segments. Traditional planning utilizes standing radiographs, but the value of sitting radiographs to predict thoracic flexibility has not been investigated. Authors of the present study propose that alignment changes from a sitting to a standing position will predict changes in unfused thoracic segments after TLD correction.METHODSPatients with degenerative spine pathology underwent preoperative sitting and standing full-spine stereotactic radiography. A subset of TLD patients who had undergone corrections with minimum T10-pelvis fusions was analyzed in terms of pre- to postoperative alignment. Radiographic parameters were analyzed, including the T1 pelvic angle (TPA), T1–L1 pelvic angle (TLPA), lumbar pelvic angle (LPA), pelvic tilt (PT), mismatch between pelvic incidence and lumbar lordosis (PI-LL mismatch), and T2–12 kyphosis (TK). Thoracic compensation was calculated as the expected TK minus actual TK (i.e., [2/3 × PI] − actual TK). Statistical analysis consisted of paired and unpaired t-tests and linear regression analysis.RESULTSThe authors retrospectively identified 137 patients with full-body standing and sitting radiographs. The mean age of the patients was 60.9 years old, 60.0% were female, and the mean BMI was 27.8 kg/m2. The patients demonstrated significantly different radiographic alignments in baseline spinopelvic and global parameters from the preoperative sitting versus the standing positions: LL (−34.20° vs −47.87°, p < 0.001), PT (28.31° vs 17.50°, p < 0.001), TPA (27.85° vs 16.89°, p < 0.001), TLPA (10.63° vs 5.17°, p < 0.001), and LPA (15.86° vs 9.67°, p < 0.001). Twenty patients (65.0% female) with a mean age of 65.3 years and mean BMI of 30.2 kg/m2 had TLD and underwent surgical correction (pre- to postoperative standing change in TPA: 33.90° to 24.50°, p = 0.001). Preoperative sitting radiographs demonstrated significant differences in alignment compared to postoperative standing radiographs: larger TPA (39.10° vs 24.50°, p < 0.001), PT (35.40° vs 28.10°, p < 0.001), LL (−11.20° vs −44.80°, p < 0.001), LPA (22.80° vs 14.20°, p < 0.001), and unfused Cobb (T2 to upper instrumented vertebra [UIV] Cobb angle: 19.95° vs 27.50°, p = 0.039). Also in the TLD group, mean thoracic compensation was 6.75°. In the linear regression analysis, the change from sitting to standing predicted pre- to postoperative changes for TK and the unfused thoracic component of TPA (5° change in preoperative sitting to preoperative standing corresponded to a pre- to postoperative change in standing TK of 6.35° and in standing TPA of 7.23°, R2 = 0.30 and 0.38, respectively).CONCLUSIONSSitting radiographs were useful in demonstrating spine flexibility. Among the TLD surgery group, relaxation of the unfused thoracic spine in the sitting position predicted the postoperative increase in kyphosis of the unfused thoracic segments. Sitting radiographs are a useful tool to anticipate reciprocal changes in thoracic alignment that diminish global corrections.
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Grammatopoulos, G., W. Gofton, M. Cochran, J. Dobransky, A. Carli, H. Abdelbary, H. S. Gill, and P. E. Beaulé. "Pelvic positioning in the supine position leads to more consistent orientation of the acetabular component after total hip arthroplasty." Bone & Joint Journal 100-B, no. 10 (October 2018): 1280–88. http://dx.doi.org/10.1302/0301-620x.100b10.bjj-2018-0134.r1.
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Aims This study aims to: determine the difference in pelvic position that occurs between surgery and radiographic, supine, postoperative assessment; examine how the difference in pelvic position influences subsequent component orientation; and establish whether differences in pelvic position, and thereafter component orientation, exist between total hip arthroplasties (THAs) performed in the supine versus the lateral decubitus positions. Patients and Methods The intra- and postoperative anteroposterior pelvic radiographs of 321 THAs were included; 167 were performed with the patient supine using the anterior approach and 154 were performed with the patient in the lateral decubitus using the posterior approach. The inclination and anteversion of the acetabular component was measured and the difference (Δ) between the intra- and postoperative radiographs was determined. The target zone was inclination/anteversion of 40°/20° (± 10°). Changes in the tilt, rotation, and obliquity of the pelvis on the intra- and postoperative radiographs were calculated from Δinclination/anteversion using the Levenberg–Marquardt algorithm. Results The mean postoperative inclination/anteversion was 40° (± 8°)/23° (± 9°) with Δinclination and/or Δanteversion > ± 10° in 74 (21%). Intraoperatively, the pelvis was anteriorly tilted by a mean of 4° (± 10°), internally rotated by a mean of 1° (± 10°) and adducted by a mean of 1° (± 5°). Having Δinclination and/or Δanteversion > ± 10° was associated with a 3.5 odds ratio of having the acetabular component outside the target zone. A greater proportion of THAs that were undertaken with the patient in the lateral decubitus position had Δinclination and/or Δanteversion > ± 10° (35.3%, 54/153) compared with those in the supine position (4.8%, 8/167; p < 0.001). A greater number of acetabular components were within the target zone in THAs undertaken with the patient in the supine position (72%, 120/167), compared with those in the lateral decubitus position (44%, 67/153; p < 0.001). Intraoperatively, the pelvis was more anteriorly tilted (p < 0.001) and more internally rotated (p = 0.04) when the patient was in the lateral decubitus position. Conclusion The pelvic position is more reliable when the patient is in the supine position, leading to more consistent orientation of the acetabular component. Significant differences in pelvic tilt and rotation are seen with the patient in the lateral decubitus position. Cite this article: Bone Joint J 2018;100-B:1280–8.
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Schwarz, Timo Julian, Markus Weber, Christian Dornia, Michael Worlicek, Tobias Renkawitz, Joachim Grifka, and Benjamin Craiovan. "Correction of Pelvic Tilt and Pelvic Rotation in Cup Measurement after THA – An Experimental Study." RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren 189, no. 09 (July 11, 2017): 864–73. http://dx.doi.org/10.1055/s-0043-110012.
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Purpose Accurate assessment of cup orientation on postoperative pelvic radiographs is essential for evaluating outcome after THA. Here, we present a novel method for correcting measurement inaccuracies due to pelvic tilt and rotation. Method In an experimental setting, a cup was implanted into a dummy pelvis, and its final position was verified via CT. To show the effect of pelvic tilt and rotation on cup position, the dummy was fixed to a rack to achieve a tilt between + 15° anterior and -15° posterior and 0° to 20° rotation to the contralateral side. According to Murray’s definitions of anteversion and inclination, we created a novel corrective procedure to measure cup position in the pelvic reference frame (anterior pelvic plane) to compensate measurement errors due to pelvic tilt and rotation. Results The cup anteversion measured on CT was 23.3°; on AP pelvic radiographs, however, variations in pelvic tilt (± 15°) resulted in anteversion angles between 11.0° and 36.2° (mean error 8.3°± 3.9°). The cup inclination was 34.1° on CT and ranged between 31.0° and 38.7° (m. e. 2.3°± 1.5°) on radiographs. Pelvic rotation between 0° and 20° showed high variation in radiographic anteversion (21.2°–31.2°, m. e. 6.0°± 3.1°) and inclination (34.1°–27.2°, m. e. 3.4°± 2.5°). Our novel correction algorithm for pelvic tilt reduced the mean error in anteversion measurements to 0.6°± 0.2° and in inclination measurements to 0.7° (SD± 0.2). Similarly, the mean error due to pelvic rotation was reduced to 0.4°± 0.4° for anteversion and to 1.3°± 0.8 for inclination. Conclusion Pelvic tilt and pelvic rotation may lead to misinterpretation of cup position on anteroposterior pelvic radiographs. Mathematical correction concepts have the potential to significantly reduce these errors, and could be implemented in future radiological software tools. Key Points Citation Format
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Martins, J., B. Colaco, S. Alves-Pimenta, A. Ferreira, and M. Ginja. "Effects of pelvis rotation on the projected radiographic position of the femoral head in relationship to the acetabulum." Veterinární Medicína 62, No. 7 (July 25, 2017): 377–85. http://dx.doi.org/10.17221/127/2016-vetmed.
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The aim of this study was to describe the influence of pelvis rotation on the projected radiographic position of the femoral head in relationship to the acetabulum in the standard ventrodorsal hip extended view, i.e. Norberg angle, pelvic thickness at the level of the cranial effective acetabular rim, femoral head subluxation index, femoral head subluxation category and femoral head-acetabular distance. Twelve adult dogs of large and giant breeds were radiographed in standard hip extended view and with 2°, 4° and 6° of rotation on the right and left sides. Norberg angle, pelvic thickness, subluxation index, subluxation category and femoral head-acetabular distance were measured on radiographs and analysed comparing a normal position with positions of different degrees of rotation for the dependent and non-dependent side. All the studied parameters showed adequate repeatability. Norberg angle and femoral head-acetabular distance did not show significant mean differences in all degrees of rotated pelvis (P > 0.05). The pelvic thickness showed an increase with the degree of rotation on the dependent side (P < 0.05) and a slight decrease on the non-dependent side (P > 0.05). The subluxation index and subluxation category showed an increase with the degree of rotation on the dependent side and a decrease on the non-dependent side (P < 0.05). As the subluxation index and subluxation category are parameters used in the classification of the main international hip dysplasia scoring systems, pelvic rotation can impair the final hip score, especially in scoring systems that are based on the worst joint.
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Khan, Adam Z., Sara Putnam, Arya Minaie, John Clohisy, and Jeffrey J. Nepple. "DO ALTERATIONS IN PELVIC ROTATION ON THE FALSE PROFILE RADIOGRAPH EFFECT THE APPARENT AIIS MORPHOLOGY?" Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (March 1, 2019): 2325967119S0001. http://dx.doi.org/10.1177/2325967119s00017.
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Background: Prominence of the anterior inferior iliac spine (AIIS) may contribute to femoroacetabular impingement (FAI). Identification and classification of these morphologic variants are important to evaluation and treatment of symptomatic impingement. A standard hip radiographic series including false profile radiographs are commonly used for assessment of AIIS morphology, despite 3D-CT imaging being the gold standard. Yet, obtaining the accurate degree of rotation necessary for precise false profile radiographs in the office is difficult, often leaving the clinician to interpret radiographs with non-standard pelvic rotation. The purpose of this study is to investigate the effects of pelvic rotation of false profile radiographs on perceived AIIS morphology. Methods: Fifteen cadaveric hips (8 pelvises: 4 male, 4 females; 68-92 years of age) without evidence of prior surgery or osteoarthritis were obtained. Samples were fixed to a custom jig in neutral pelvic tilt and rotation. An AP pelvis and radiographic images from 450 to 850 of rotation at 50 intervals were taken, with 650 designated as a true false profile view. A single grader identified the morphology of the AIIS deformities on false profile views as well as measurement of the AIIS offset of each cadaver in 5 degree increments of rotation from 45 to 85 degrees (65 degree true false profile). Interobserver and intraobserver reliability was assessed in a random subset of 20 views. Paired t-test was used to evaluate significance of AIIS offset at varying degrees of pelvic rotation. Results: Significant increases (p < 0.05) in measured AIIS offset were observed with each subsequent increase of 50 of pelvic rotation (greater AIIS offset seen with increased pelvic rotation towards lateral). Mean AIIS offset values for each 50 of rotation are shown in Figure 1. Figure 2 shows examples of observed differences in AIIS offset at both extremes of rotation relative to a true false profile. There was strong inter- and intra-observer reliability for AIIS offset (0.920 and 0.965), especially compared to measured femoral head diameter (0.657 and 0.779). Conclusion: Significant variation in measurement of AIIS offset on false profile radiographs was observed based on degree of pelvic rotation. Increased prominence of AIIS (decreased AIIS offset) was noted with decreased pelvic rotation (away from true lateral view). These findings stress the importance of clinician caution and close attention to pelvic positioning with radiographic evaluation of AIIS prominence.
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Bracey, Daniel N., Vishal Hegde, Andrew J. Shimmin, Jason M. Jennings, Jim W. Pierrepont, and Douglas A. Dennis. "Spinopelvic mobility affects accuracy of acetabular anteversion measurements on cross-table lateral radiographs." Bone & Joint Journal 103-B, no. 7 Supple B (July 1, 2021): 59–65. http://dx.doi.org/10.1302/0301-620x.103b7.bjj-2020-2284.r1.
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Aims Cross-table lateral (CTL) radiographs are commonly used to measure acetabular component anteversion after total hip arthroplasty (THA). The CTL measurements may differ by > 10° from CT scan measurements but the reasons for this discrepancy are poorly understood. Anteversion measurements from CTL radiographs and CT scans are compared to identify spinopelvic parameters predictive of inaccuracy. Methods THA patients (n = 47; 27 males, 20 females; mean age 62.9 years (SD 6.95)) with preoperative spinopelvic mobility, radiological analysis, and postoperative CT scans were retrospectively reviewed. Acetabular component anteversion was measured on postoperative CTL radiographs and CT scans using 3D reconstructions of the pelvis. Two cohorts were identified based on a CTL-CT error of ≥ 10° (n = 11) or < 10° (n = 36). Spinopelvic mobility parameters were compared using independent-samples t-tests. Correlation between error and mobility parameters were assessed with Pearson’s coefficient. Results Patients with CTL error > 10° (10° to 14°) had stiffer lumbar spines with less mean lumbar flexion (38.9°(SD 11.6°) vs 47.4° (SD 13.1°); p = 0.030), different sagittal balance measured by pelvic incidence-lumbar lordosis mismatch (5.9° (SD 18.8°) vs -1.7° (SD 9.8°); p = 0.042), more pelvic extension when seated (pelvic tilt -9.7° (SD 14.1°) vs -2.2° (SD 13.2°); p = 0.050), and greater change in pelvic tilt between supine and seated positions (12.6° (SD 12.1°) vs 4.7° (SD 12.5°); p = 0.036). The CTL measurement error showed a positive correlation with increased CTL anteversion ( r = 0.5; p = 0.001), standing lordosis ( r = 0.23; p = 0.050), seated lordosis ( r = 0.4; p = 0.009), and pelvic tilt change between supine and step-up positions ( r = 0.34; p = 0.010). Conclusion Differences in spinopelvic mobility may explain the variability of acetabular anteversion measurements made on CTL radiographs. Patients with stiff spines and increased compensatory pelvic movement have less accurate measurements on CTL radiographs. Flexion of the contralateral hip is required to obtain clear CTL radiographs. In patients with lumbar stiffness, this movement may extend the pelvis and increase anteversion of the acetabulum on CTL views. Reliable analysis of acetabular component anteversion in this patient population may require advanced imaging with a CT scan. Cite this article: Bone Joint J 2021;103-B(7 Supple B):59–65.
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Bodendorfer, Blake, Vishal Mehta, Kenneth Tepper, and Austin Looney. "Comparison of Joint Space Measurements between Supine and Weightbearing Anteroposterior Pelvis Radiographs for Patients Undergoing Hip Arthroscopy." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0034. http://dx.doi.org/10.1177/2325967120s00347.
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Objectives: Osteoarthritis and joint space narrowing of the hip have been correlated with poor outcomes and conversion to arthroplasty after hip arthroscopy. However, a standardized protocol for radiographic measurement of minimal joint space width of the hip has not been developed. We hypothesized that minimal joint space width would be significantly lower on the affected side in weightbearing anteroposterior pelvis radiographs versus supine radiographs. We also hypothesized that radiographs with single-leg stance would show the lowest minimal joint space width. Methods: Thirty-one consecutive adult patients with hip pain were prospectively enrolled and each had single-leg and double-leg weightbearing and supine anteroposterior pelvis radiographs in a standardized position. Two independent investigators determined minimal joint space width. Differences between minimal JSW as well as intra- and interobserver reliability were calculated. One and 2-way analyses of variance (ANOVA) were used to compare the measurements. Power analysis determined that recruitment of 30 patients was necessary to achieve 90% power. P<0.05 was considered significant. Results: No significant differences in joint space width were found between supine or weightbearing radiographs for any pelvis site (Figure 1). Comparing those under 50 years of age to those older than 50 years of age, mean joint space width was 3.5±0.5 vs. 3.0±0.9 in the supine position, 3.2±0.8 vs. 3.0±1.0 during double-leg stance, and 3.5±0.5 vs. 3.0±1.1 during single-leg stance (P=0.002). Conclusion: Our data showed no significant difference in joint space width among anteroposterior single-leg or double-leg weightbearing or supine radiographs at any location measured. These findings suggest that either weightbearing or supine radiographs can be used to evaluate hip joint space width and that all locations provide a similar indication of joint space width. These findings support the use of a single view for the evaluation of JSW in patients with hip pain, which may allow for a less burdensome clinical workflow. [Table: see text]
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Forness, Mikayla, Zachary Podoll, Benjamin Noonan, and Alexander Chong. "Biomechanical Evaluation of the Accuracy in Radiographic Assessment of Femoral Component Migration Measurement after Total Hip Arthroplasty." Kansas Journal of Medicine 13, no. 1 (April 17, 2020): 65–70. http://dx.doi.org/10.17161/kjm.v13i1.13622.
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Introduction: Implant subsidence is one criteria utilized to monitor for prosthesis loosening after total hip arthroplasty (THA) with initial implant subsidence assessment often done utilizing plain radiographs. The specific aim of this study was to identify the most reliable references when using plain radiographs to establish an image magnification with the goals being easy to use, inexpensive, reliable, and accurate.
Methods: Two femoral stem implants (stem lengths: 127mm, 207mm) were utilized to simulate hemiarthroplasty of the hip with composite femurs. Different combinations of femoral stem distances from the radiographic film (ODD), source-detector differences (SDD), hip rotation, and hip flexion were elected. Standardized anterior-posterior pelvis for each parameter combination setup were taken. Radiographic measurements (head diameter, stem length, stem seating length) were undertaken five times by three examiners. Radiographic image magnification factors were generated from two references (head diameter and stem length). Radiograph measurement reproducibility and stem seating length errors using these magnification factors were evaluated.
Results: High level of repeated measurements reliability was found for head diameter (99 ± 0%) and stem length (90 ± 7%) measurements, whereas seating length measurements were less reliable (76 ± 6%). Stem length error using the femoral head magnification factor yielded 11% accuracy. Stem seating length error using both magnification factors were not reliable (< 7% accuracy). All parameters, except SDD, showed significant effect on calibrated measurement error.
Conclusions: Current methods of assessing implant subsidence after THA using plain radiographs are inaccurate or reliable. Clinicians should recognize these limitations and be cautious when diagnosing implant stability using plain radiographs alone.
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Kazarian, Gregory S., Derek T. Schloemann, Toby N. Barrack, Charles M. Lawrie, and Robert L. Barrack. "Pelvic rotation after total hip arthroplasty is dynamic and variable." Bone & Joint Journal 102-B, no. 7_Supple_B (July 2020): 47–51. http://dx.doi.org/10.1302/0301-620x.102b7.bjj-2019-1614.r2.
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Aims The aims of this study were to determine the change in the sagittal alignment of the pelvis and the associated impact on acetabular component position at one-year follow-up after total hip arthroplasty (THA). Methods This study represents the one-year follow-up of a previous short-term study at our institution. Using the patient population from our prior study, the radiological pelvic ratio was assessed in 91 patients undergoing THA, of whom 50 were available for follow-up of at least one year (median 1.5; interquartile range (IQR) 1.1 to 2.0). Anteroposterior radiographs of the pelvis were obtained in the standing position preoperatively and at one year postoperatively. Pelvic ratio was defined as the ratio between the vertical distance from the inferior sacroiliac (SI) joints to the superior pubic symphysis and the horizontal distance between the inferior SI joints. Apparent acetabular component position changes were determined from the change in pelvic ratio. A change of at least 5° was considered clinically meaningful. Results Pelvic ratio decreased (posterior tilt) in 54.0% (27) of cases, did not change significantly in 34.0% (17) of cases, and increased (anterior tilt) in 12.0% (6) of cases when comparing preoperative to one-year postoperative radiographs. This would correspond with 5° to 10° of abduction error in 22.0% of cases and > 10° of error in 6.0%. Likewise, this would correspond with 5° to 10° of version error in 22.0% of cases and > 10° of error in 44.0%. Conclusion Pelvic sagittal alignment is dynamic and variable after THA, and these changes persist to the one-year postoperative period, altering the orientation of the acetabular component. Surgeons who individualize the acetabular component placement based on preoperative functional radiographs should consider that the rotation of the pelvis (and thus the component version and inclination) changes one year postoperatively. Cite this article: Bone Joint J 2020;102-B(7 Supple B):47–51.
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Sanjo, Emi, Fumihiko Tamamoto, Shoichi Ogawa, Maiko Sano, Tetsunori Yoshimura, and Miwako Nozaki. "Unexpected Radiologic Findings for a Casting Type of Radiolucent Colorectal Foreign Body Composed of Polyurethane Foam." Case Reports in Radiology 2016 (2016): 1–3. http://dx.doi.org/10.1155/2016/4987105.
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Radiologic diagnosis of colorectal foreign bodies is usually not very difficult, because inserted materials are often clearly visible on plain abdominal radiographs. However, when they are radiolucent, a plain abdominal radiograph has been reported to be useless. As radiolucent colorectal foreign bodies appear as radiolucent artificial contours or air-trapped materials in the pelvis, almost always the diagnosis itself can be made by careful evaluation of plain abdominal radiographs. We encountered a case of casting type of radiolucent colorectal foreign body formed from polyurethane foam. It presented us with unexpected radiologic findings and led to diagnostic difficulties.
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Sung, S., S. Lim, H. Oh, K. Kim, Y. Choi, and K. Lee. "Atypical radiographic features of multiple myeloma in a dog: a case report." Veterinární Medicína 62, No. 9 (September 20, 2017): 522–26. http://dx.doi.org/10.17221/140/2016-vetmed.
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A 12-year-old castrated male miniature pinscher dog presented with right forelimb lameness. An expansile osteolytic lesion of the right humerus was conspicuous on right forelimb radiographs. Thoracic and abdominal radiographs showed multiple lytic bone lesions on the right scapula, ribs, vertebrae, femurs and pelvis. Additionally, an expansile osteolytic lesion was observed in two thoracic vertebrae and two ribs. Many plasma cells were identified on fine-needle aspiration of the right humerus expansile osteolytic lesion, and monoclonal gammopathy consistent with multiple myeloma was confirmed on serum protein electrophoresis. The expansile osteolytic lesion, an extraordinary radiographic feature of multiple myeloma in dogs, should be considered as a possible radiographic finding of multiple myeloma.
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Nicastro, Andrea, and Richard Walshaw. "Chronic Vaginitis Associated With Vaginal Foreign Bodies in a Cat." Journal of the American Animal Hospital Association 43, no. 6 (November 1, 2007): 352–55. http://dx.doi.org/10.5326/0430352.
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A 2-year-old, spayed female, domestic shorthaired cat was presented for evaluation of a chronic, purulent vulvar discharge. Survey radiographs of the abdomen and pelvis revealed bone fragments in the pelvic canal. A vaginoscopy was performed, and five bony foreign bodies were removed from the vaginal lumen. Using anatomical landmarks, the bones were identified as remnants of a fetal kitten.
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Raj, Manish, Ashish Jaiman, and Rajesh Kumar Chopra. "Evaluation of version of acetabular component following total hip replacement on conventional radiograph and computed tomography." Journal of Orthopaedics, Trauma and Rehabilitation 27, no. 2 (August 11, 2020): 179–85. http://dx.doi.org/10.1177/2210491720942887.
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Background/Purpose: Total hip replacement (THR) is considered as one of the most successful orthopedic procedures. However, improperly placed components can lead to instability and accelerated wear. Acetabular cup inclination can be very well accessed by anteroposterior pelvis X-rays; for acetabular version assessment, computed tomography (CT) scan is the gold standard. CT scan is not readily available at many centers and the surgeon has to rely on X-ray methods for evaluation of acetabular version to audit results and to predict behavior of the surgical intervention. This prospective study was undertaken to compare Woo and Morrey’s and ischiolateral methods of assessment of acetabular version on cross-table lateral radiographs with CT assessment and to assess the validity of radiographic methods with respect to CT scan method. Material and methods: A prospective follow-up study was conducted for 18 months’ duration (October 2016 to March 2018) on 30 adult patients who underwent THR surgery. Cross-table lateral radiograph was obtained at 3 and 6 weeks in the postoperative period. Two observers made each observation at two different points of time. CT scan was performed at 3 weeks. Version as measured by radiographs and CT scan was recorded. Results: The major overlap in the distribution of the values of the Woo and Morrey method suggests that there is no significant difference between the observations. Distribution of the values of the ischiolateral view and the CT scan value distributions have a very small overlap and hence suggest a strong significant difference between the two. Conclusion: In this study, Woo and Morrey’s method and ischiolateral method of assessment of acetabular version were compared with CT assessment. We found that in Woo and Morrey’s method, values were comparable to CT scan values, when put on regression line. However, in situation of change in patient positioning, namely hip stiffness in contralateral hip, measurement of component changed in series of radiography due to differences in pelvis tilt. So, in these circumstances, we can use ischiolateral method which can give consistent measurement. But it will not be in concordance with CT scan values and Woo and Morrey values, as represented in regression line. The high intra-class correlation coefficients for both intra- and inter-observer reliability indicated that the angle measured with these methods is consistent and reproducible for multiple observers. CT, however, be considered as gold standard for measurement owing to control over pelvic rotation and/or tilt/patient positioning.
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Grimes, Janet A., Adrien-Maxence Hespel, Robert C. Cole, and A. Ray Dillon. "A Case of Parasitic Twinning or Caudal Duplication in a Dog." Journal of the American Animal Hospital Association 54, no. 4 (July 1, 2018): 219–25. http://dx.doi.org/10.5326/jaaha-ms-6559.
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ABSTRACT A 6 mo old 13.5 kg (29.7 lb) male intact American Staffordshire terrier was evaluated for a history of supernumerary pelvic limbs, with malodorous discharge from a supernumerary penis. Imaging (radiographs, abdominal ultrasound, and computed tomography with excretory urogram) showed a supernumerary pelvis with associated pelvic limbs, no osseous continuity with the primary spinal column, a colonic diverticulum extending to the supernumerary pelvis, an enlarged left kidney with a ureter connecting to a single bladder, right renal aplasia, a single descended testicle in the primary scrotum, an intra-abdominal cryptorchid testicle, and two unidentifiable soft tissue masses. At surgery, a single ileum was present with a primary and accessory cecum and colon and the accessory colon entering the supernumerary pelvis. The accessory cecum and colon, right kidney, two unknown soft tissue masses, and the single descended testicle were removed. The right kidney had a ureter that anastomosed with the accessory colon at its entry into the supernumerary pelvis. The supernumerary pelvis and hind limbs were not removed. Five months after surgery, the dog was reported to be doing well clinically. Caudal duplication is extremely rare in veterinary medicine. The appearance of supernumerary external structures may indicate internal connections as well.
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Burkus, Máté, István Márkus, Bálint Niklai, and Miklós Tunyogi-Csapó. "A keresztcsonti ízület mobilitásának vizsgálata derékpanaszos betegcsoportban." Orvosi Hetilap 158, no. 52 (December 2017): 2079–85. http://dx.doi.org/10.1556/650.2017.30921.
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Abstract: Introduction: Sagittal alignment of the pelvis is typically characterized using three fundamental parameters. Among these, pelvic incidence is traditionally considered to be anatomically ‘constant’. Aim: We aimed to analyze the pelvic parameters of low back pain patients with suspected sacroiliac joint laxity. Method: Pelvic parameters were assessed in standing and seated EOS 2D/3D radiographs of 48 cases of persistent low back pain, and compared to upper body position using cluster analysis and t-test. Results: Median pelvic incidence did not differ statistically between standing and sitting (47.8°–47.7°). However, in individual analysis 7 cases (15%) exhibited a forward tilt in their upper body with an increased pelvic incidence, and 7 cases (15%) showed a backward upper body tilt. No change was found in 34 cases. Conclusion: Our results indicate the pelvis should not be regarded as a rigid unit, as in some cases significant appreciable sacroiliac joint laxity can occur. Orv Hetil. 2017; 158(52): 2079–2085.
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Kulkarni, V. A., J. R. Davids, A. D. Boyles, N. Q. Cung, and A. Bagley. "Reliability and efficiency of three methods of calculating migration percentage on radiographs for hip surveillance in children with cerebral palsy." Journal of Children's Orthopaedics 12, no. 2 (April 2018): 145–51. http://dx.doi.org/10.1302/1863-2548.12.170189.
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Purpose Hip surveillance programmes for children with cerebral palsy (CP) utilize the migration percentage (MP) measurement to initiate referrals and recommend treatment. This study assesses the reliability and efficiency of three methods of MP measurement on anteroposterior (AP) pelvis radiographs. Methods A total of 20 AP pelvis radiographs (40 hips) of children with CP were measured by three raters on two occasions using three methods: digital measurement (DM) on a Picture Archiving and Communication System monitor, computer-aided measurement (CA) using a digital templating tool and mobile device application measurement (MA) using a freely available MP measurement tool. For each method, the time required to complete the MP measurement of both hips on each AP pelvis radiograph was measured. Intra-class correlation coefficient (ICC) was used to determine reliability, and analysis of variance was used to compare groups. Results All three methods of determining MP showed excellent inter-rater and intra-rater reliability (ICC 0.976 to 0.989). The mean absolute difference in MP measurement was not significant between trials for a single rater (DM 2.8%, CA 1.9%, MA 2.2%) or between raters (DM 3.6%, CA 2.9%, MA 3.6%). The mean time to complete MP measurement was significantly different between methods, with DM = 151 seconds, CA = 73 seconds and MA = 80 seconds. Conclusion All three MP measurement methods were highly reliable with clinically acceptable measurement error. The time required to measure a hip surveillance radiograph can be reduced by approximately 50% by utilizing a computer-based or mobile application-based MP measurement tool. Level of Evidence III
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Wimsey, S., R. Pickard, and G. Shaw. "Accurate scaling of digital radiographs of the pelvis." Journal of Bone and Joint Surgery. British volume 88-B, no. 11 (November 2006): 1508–12. http://dx.doi.org/10.1302/0301-620x.88b11.18017.
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Bizimi, V., P. Katsimbri, A. Plousi, D. Tseronis, N. Sideri, E. Efstathopoulos, D. Boumbas, N. Kelekis, and O. Papakonstantinou. "SAT0550 SPINAL AND PELVIC MDCT USING “iDose5” ITERATIVE RECONSTRUCTION ALGORITHM IN PATIENTS WITH PSORIATIC SPONDYLOARTHRITIS: DIAGNOSTIC CAPABILITIES AND IMAGE QUALITY IN RELATION TO RADIATION EXPOSURE." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1232–33. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6631.
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Background:Psoriatic spondyloarthritis (PsSpA) is an inflammatory arthritis related to psoriasis, whereas a large number of patients may have persistent inflammation developing gradual and in some cases extensive joint involvement of the axial skeleton.Conventional radiographs (CRs) have been used for the detection of structural damage (syndesmophyte formation, paravertebral ossification, sacroiliitis, ankyloses and erosions), facilitating as an important measure of efficacy of various therapies. However overlapping of anatomic structures of pelvis and spine as well as limited capabilities to visualize soft tissue have led to the development of newer imaging technologies (1). Multidetector CT technology (MDCT), it is now possible to perform low dose CT (ldCT) of the entire vertebral column, viewed in multiple planes and without overprojection with a low radiation dose. (2) Still, the capabilities of ldCT algorithms in the diagnosis and progression of PsSpA has not been fully explored.Objectives:The aim of this study is to examine the effect of “iDose5” iterative reconstruction algorithm on radiation dose, diagnostic capabilities and image quality in spine-pelvis (S-P) CT scanning compared with CRs, in detection of findings suggestive of PsSpA.Methods:Thirty-nine patients with PsSpA (26 females and 13 males, age range: 23 to 70 years old) were prospectively studied with “iDose5” CT of spine and pelvis on a 64-row MDCT scanner. Multiplannar reformats followed. All patients satisfied the Psoriatic Arthritis (CASPAR) classification criteria and had undergone standard AP and lateral CRs of the cervical, thoracic and lumbar spine and AP radiographs of the pelvis within one months of the iDose CT. Twenty-five patients underwent, additional MR imaging (MRI) of the same anatomic areas. Written consent was obtained from all patients. Two musculoskeletal radiologists read and scored CT scans and CRs in consensus, according to the PASRI criteria and the CTSS score. CT image quality and effective dose for CT and radiographs were assessed.All data were analyzed using SPSS 24.0 statistical software.Results:CT revealed erosions and ankyloses of the sacroiliac joints, fusion of the posterior elements of vertebra especially in the thoracic spine, enthesophytes, not seen with CRs, in 26 patients (p<0,05).Level of diagnostic confidence was higher when interpreting CT compared to CRs, in cases of erosions and ankyloses, in 35 patients (p<0,05).CT was slightly superior in the detection and characterization of syndesmophytes, enthesopathy and calcifications.Effective dose for “i-Dose 5” CT was 1.20 ± 0.26 mSv and for CR =1.07 ± 0.21 mSv. The difference was not statistically significant (p=0.588).Conclusion:iDose CT of spine and pelvis at an effective dose, lower than previously published, seems to perform better than radiographs in the detection of structural changes of PsSpA. Further studies are needed to document the capabilities of iDose CT for the imaging assessment of PsSpA in daily clinical practice.References:[1]Baraliakos Χ, et al (2009)The Natural Course of Radiographic Progression in Ankylosing Spondylitis — Evidence for Major Individual Variations in a Large Proportion of Patients The Journal of Rheumatology May, 36 (5) 997-1002[2]de Koning A et, al (2018) Low-dose CT detects more progression of bone formation in comparison to conventional radiography in patients with ankylosing spondylitis: results from the SIAS cohort. Ann Rheum Dis.;77(2):293-299.Disclosure of Interests:None declared
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Wink, F., T. Diemel, S. Arends, and A. Spoorenberg. "POS0034 RADIOGRAPHIC ENTHESEAL LESIONS AT HIP AND PELVIC REGION ARE ASSOCIATED WITH LONGER DISEASE DURATION, HIGHER BMI AND MORE SEVERE SPINAL AND HIP RADIOGRAPHIC DAMAGE IN PATIENTS WITH ANKYLOSING SPONDYLITIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 223.2–223. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3057.
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Background:Enthesitis is an important feature of ankylosing spondylitis (AS) and structural and inflammatory entheseal lesions (EL) are frequently present on ultrasound. Plain radiographs also provide good imaging of structural entheseal involvement1. Until now, little is known about the presence of structural EL at the hip and pelvic region and the association with patient characteristics in AS.Objectives:Our aim was to investigate the prevalence of radiographic EL at the hip and pelvic region in AS patients compared to age and sex matched control subjects and to explore the relation with AS patient characteristics.Methods:AS patients from the Groningen Leeuwarden Axial SpA (GLAS) cohort, included between November 2004 and December 2010, with available anteroposterior (AP) pelvis radiographs at baseline were included. All patients fulfilled the modified New York criteria for AS. Additionally, 100 randomly selected AP pelvis radiographs from age and sex matched control subjects were obtained from the radiology department of the University Medical Center Groningen. The sacroiliac joints of all radiographs were blinded and radiographs were scored independently by two trained observers unaware of patient characteristics and treatment. The entheseal sites scored were: trochanter major, trochanter minor, os ischium, crista iliaca, both left and right side. The following 3 EL were scored: erosion/cortical irregularity, calcification and enthesophyte. Only lesions with absolute agreement between both observers were used for analyses. Radiographic spinal involvement was scored according to the modified Stoke AS Spine Score (mSASSS; range 0-72) and radiographic hip involvement according to the Bath AS Radiology Index (BASRI)-hip (range 0-4). Independent samples t test, Mann-Whitney U test, Chi-Square test, and Fisher Exact test were used to compare patient characteristics between patients with and without radiographic EL.Results:Of the 167 included AS patients, 117 (70%) were male, mean age was 43 ± 11 years, 133 (80%) were HLA-B27 positive and median symptom duration was 16 years (range 1-53). 127 (76%) AS patients and 58 (58%) controls showed EL, with 501 lesions in total of which 377 (75%) in AS patients. AS patients showed significantly more lesions than controls at all 5 locations. Os ischii showed the most lesions in both AS patients and controls (66% vs 53%, p<0.05). The most prevalent type of lesion in both groups was erosion/cortical irregularity (72% vs 51%, p<0.005). Enthesophytes were also more often observed in AS patients than in controls (31% vs 21%, p=0.07). Prevalence of calcifications was low in both groups and not significantly different (5% vs 2%, p=0.22). AS patients with EL were significantly older (mean 45.2 vs 35.1 yrs, p<0.005) and had longer symptom duration (median 18 vs 7.5 yrs, p<0.005) than patients without EL. Furthermore, patients with BMI >25 had significantly more often enthesophytes (42% vs 16%, p<0.05) than patients with a normal BMI. Additionally, AS patients with EL had significantly more often radiographic spinal damage than patients without EL with median mSASSS total score 8.7 vs 1.0 (p<0.005) and a trend toward significance for radiographic hip involvement (BASRI-hip score ≥2; p=0.06).Conclusion:Radiographic EL at hip and pelvic region are significantly more prevalent in AS patients than in age and sex matched controls. AS patients with EL were significantly older, had longer symptom duration and more spinal radiographic damage than patient without EL. Furthermore, BMI >25 was associated with a higher prevalence of enthesophytes. These new findings contribute to the knowledge of entheseal involvement in AS.References:[1]Voudouris et al. J Musculoskelet Neuronal Interact. 2003;3(1):89-100.Disclosure of Interests:Freke Wink Consultant of: Abbvie, Thomas Diemel: None declared, Suzanne Arends: None declared, Anneke Spoorenberg Consultant of: Abbvie, Pfizer, MSD, UCB, and Novartis, Grant/research support from: Abbvie, Pfizer, UCB and Novartis.
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Moore, Craig Steven, Tim Wood, Stephen Balcam, Liam Needler, Tim Guest, Wee Ping Ngu, Lee Wun Chong, John Saunderson, and Andrew Beavis. "Optimisation of tube voltage range (kVp) for AP abdomen, pelvis and spine imaging of average patients with a digital radiography (DR) imaging system using a computer simulator." British Journal of Radiology 93, no. 1114 (October 1, 2020): 20200565. http://dx.doi.org/10.1259/bjr.20200565.
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Objectives: To investigate via computer simulation, an optimised tube voltage (kVp) range for caesium iodide (CsI)-based digital radiography (DR) of the abdomen, pelvis and lumbar spine. Methods: Software capable of simulating abdomen, pelvis and spine radiographs was used. Five evaluators graded clinical image criteria in images of 20 patients at tube voltages ranging from 60 to 120 kVp in 10 kVp increments. These criteria were scored blindly against the same patient reconstructed at a specific reference kVp. Linear mixed effects analysis was used to evaluate image scores for each criterion and test for statistical significance. Results: Score was dependent on tube voltage and image criteria; both were statistically significant. All criteria for all anatomies scored very poorly at 60 kVp. Scores for abdomen, pelvis and spine imaging peaked at 70, 70 and 100 kVp, respectively, but other kVp values were not significantly poorer. Conclusions: Results indicate optimum tube voltages of 70 kVp for abdomen and pelvis (with an optimum range 70–120 kVp), and 100 kVp (optimum range 80–120 kVp) for lumbar spine. Advances in knowledge: There are no recommendations for optimised tube voltage parameters for DR abdomen, pelvis or lumbar spine imaging. This study has investigated and recommended an optimal tube voltage range.
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Lisson, Christoph G., Catharina S. Lisson, Daniel Vogele, Beatrice Strauss, Konrad Schuetze, Raffael Cintean, Meinrad Beer, and Stefan A. Schmidt. "Improvement of image quality applying iterative scatter correction for grid-less skeletal radiography in trauma room setting." Acta Radiologica 61, no. 6 (September 30, 2019): 768–75. http://dx.doi.org/10.1177/0284185119878348.
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Background Iterative reconstruction is well established for CT. Plain radiography also takes advantage of iterative algorithms to reduce scatter radiation and improve image quality. First applications have been described for bedside chest X-ray. A recent experimental approach also provided proof of principle for skeletal imaging. Purpose To examine clinical applicability of iterative scatter correction for skeletal imaging in the trauma setting. Material and Methods In this retrospective single-center study, 209 grid-less radiographs were routinely acquired in the trauma room for 12 months, with imaging of the chest (n = 31), knee (n = 111), pelvis (n = 14), shoulder (n = 24), and other regions close to the trunk (n = 29). Radiographs were postprocessed with iterative scatter correction, doubling the number of images. The radiographs were then independently evaluated by three radiologists and three surgeons. A five-step rating scale and visual grading characteristics analysis were used. The area under the VGC curve (AUCVGC) quantified differences in image quality. Results Images with iterative scatter correction were generally rated significantly better (AUCVGC = 0.59, P < 0.01). This included both radiologists (AUCVGC = 0.61, P < 0.01) and surgeons (AUCVGC = 0.56, P < 0.01). The image-improving effect was significant for all body regions; in detail: chest (AUCVGC = 0.64, P < 0.01), knee (AUCVGC = 0.61, P < 0.01), pelvis (AUCVGC = 0.60, P = 0.01), shoulder (AUCVGC = 0.59, P = 0.02), and others close to the trunk (AUCVGC = 0.59, P < 0.01). Conclusion Iterative scatter correction improves the image quality of grid-less skeletal radiography in the clinical setting for a wide range of body regions. Therefore, iterative scatter correction may be the future method of choice for free exposure imaging when an anti-scatter grid is omitted due to high risk of tube-detector misalignment.
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Panwar, Jyoti, Madhavi Kandagaddala, Tameem Ahmad Bhat, Charlie Chia-Tsong Hsu, and Poulomi Mitra. "The Forgotten Art of Plain Radiography in the Evaluation of Metabolic Bone Disease." Indian Journal of Musculoskeletal Radiology 2 (June 29, 2020): 3–19. http://dx.doi.org/10.25259/ijmsr_51_2019.
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Although the metabolic bone diseases are fairly commonly encountered in routine practice in India, unfortunately, the clinical presentation is quite non-specific and often remains unrecognized for years, leading to increased morbidity. In this era of advanced imaging technologies, magnetic resonance imaging (MRI) is increasingly being requested by clinicians as an initial investigation for the non-specific presentation of metabolic bone conditions, including back pain, generalized weakness, and arthralgias, and is usually largely non-contributory. Thus, the importance of plain radiographs is neglected. Although basic radiographs are frequently available at the time of MRI, it is often ignored by both the radiologists and clinicians who can lead to misdiagnosis or missed diagnosis. A variety of radiographic findings is encountered in metabolic bone diseases, though often subtle, is unceasingly diagnostic, and recognition of these findings leads to early diagnosis and treatment, resulting in improved patient outcomes. Therefore, the objective of our paper is to present a systematic approach to the interpretation of plain radiographs of the pelvis, spine, and chest that can facilitate identifying subtle imaging findings supported by complementary other region plain radiographs and laboratory data for the evaluation of metabolic bone diseases.
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Foss, O. A., J. Klaksvik, P. Benum, and S. Anda. "Pelvic rotations: a pelvic phantom study." Acta Radiologica 48, no. 6 (July 2007): 650–57. http://dx.doi.org/10.1080/02841850701326941.
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Background: Radiographic measurements made on standard pelvic radiographs are commonly used in studying conditions related to the hip joints. Effects caused by variations in pelvic orientation may be a source of error in comparing measurements between sequential radiographs. Purpose: To define and characterize parameters able to measure rotational differences separately around two axes and altered radiographic focusing along two axes when sequential standard anteroposterior (AP) pelvic radiographs are compared. Material and Methods: A pelvic phantom was constructed based on direct three-dimensional measurements of five defined landmarks in a pelvic model. Two ratios, the vertical and transversal rotation ratios, were defined using radiographs of the phantom. The phantom was radiographed in 33 different orientations and with 16 different radiographic focuses using a specially constructed tilt table. On each radiograph, measurements were made and the two rotation ratios were calculated using a measurement program. Results: Linear correlations between pelvic rotations around one axis and the corresponding rotation ratio were found with almost no influence of simultaneous rotation around the other axis. Also, linear correlations were found between altered radiographic focusing along one axis and the non-corresponding rotation ratio. Conclusion: Rotational differences around two axes or altered radiographic focusing along two axes can be measured independently. Effects caused by rotations cannot be distinguished from effects caused by altered radiographic focusing.
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Minor, Matthew, and Liem T. Bui-Mansfield. "Systematic Approach to the Interpretation of Pelvis and Hip Radiographs." Contemporary Diagnostic Radiology 37, no. 26 (December 2014): 1–7. http://dx.doi.org/10.1097/01.cdr.0000458890.88582.32.
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&NA;. "Systematic Approach to the Interpretation of Pelvis and Hip Radiographs." Contemporary Diagnostic Radiology 37, no. 26 (December 2014): 8. http://dx.doi.org/10.1097/01.cdr.0000458891.96205.f4.
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Pilgram, Roland, Claudia Walch, Michael Blauth, Werner Jaschke, Rainer Schubert, and Volker Kuhn. "Knowledge-based femur detection in conventional radiographs of the pelvis." Computers in Biology and Medicine 38, no. 5 (May 2008): 535–44. http://dx.doi.org/10.1016/j.compbiomed.2008.01.010.
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