Journal articles on the topic 'Tube-source radiography'

We systematically investigated the effect of tube angulation on angular distortion of the anteroposterior radiograph of the foot. Three-dimensional data from the metatarsals originating from computed tomographic scans of ten healthy volunteers were projected onto the supporting surface at various tube angulations to simulate radiography. The distortion of the intermetatarsal angles decreased from 1.2° to 3.5° at 20° tube angulation to 0.4° to 2.7° at 0° tube angulation. The relatively small improvement in angular measurement using 0° instead of 15° tube angulation would not outweigh the adverse effects of changing the standard radiographic technique. Physician awareness of this source of error when planning surgical therapy seems more important. (J Am Podiatr Med Assoc 95(4): 370–375, 2005)

Purpose: Any use of ionizing radiation must be justifi ed and the benefi t must be greater than the harm it causes. Imaging must be performed with the lowest possible dose received by the patient, while maintaining optimal radiographic image quality. Imaging of the lumbar spine is a relatively high dose imaging procedure. This systematic review aims to explore optimisation options to reduce patient exposure, while maintaining radiographic quality during plain lumbar spine imaging. Methods: A systematic review of the literature from the databases Pub Med Central, EBSCOhost including CINAHL, Cochrane Library, Web of Science, Science Direct, DiKUL and Springer Link was conducted. The documents were fully accessible and in the English language. Results: 26 experimental studies were included in the analysis. There are many optimisation methods: changing the tube potential, comparison of diff erent projections, use of shielding, primary beam collimation, increasing the source-to-image receptor distance, compression of the imaged area, using the air gap technique, evaluation of the need for additional projections, and rotating the patient depending on the tube side. On average, the dose is reduced by 44%. Studies that also evaluated the quality of radiographs found all radiographs to be diagnostically acceptable. Conclusion: The results confi rm a reasonable use of methods to optimize radiation exposure and to maintain an optimal image quality of radiographs. A systematic review for each specifi c area in general radiography should be conducted in the future. Keywords: lumbar spine imaging, optimisation, dose reduction, low dose, image quality

Abdominal radiography is beneficial in a variety of clinical situations. Prior to the introduction of multiplanar imaging, it was considered as the main examination for gastrointestinal pathology. However, the radiation dose received is considered high since it is equivalent to the dose of at least 75 chest radiographs. Personnel including staff or relatives may be required to assist patients in many conditions, increasing unnecessary radiation and the likelihood of radiation-induced cancer. The purpose of this study was to determine the radiation dose received by personnel when eyes and thyroid are exposed during abdominal radiography. The Rando and body phantoms were used to represent personnel and patients in this experimental approach. The dose was measured as entrance surface dose (ESD) by using TLD-100, which was positioned at the Rando phantom's eyes and thyroid. The study included a total of twenty exposures, five times at each of four distinct sites. The mean doses (eyes/thyroid in mGy) were (0.083/0.081), (0.090/0.087), (0.093/0.092), and (0.092/0.089), respectively, at locations 1, 2, 3, and 4. The results indicated that there was no correlation between organ and location affecting ESD measurement (p=0.960). There was no significant difference in dose between the two organs (p=0.355), with the mean difference in the eyes being 0.002 more than in the thyroid. The proximity of the eyes to the tube source contributed for the increased dose observed at the eyes. Though ESD was substantial for location pairings 1 vs. 3 (p=0.001) and 1 vs. 4 (p=0.015) owing to the anode-cathode phenomena. In conclusion, personnel should avoid the tube source and cathode region, since they give a greater dose of radiation, particularly when the personnel are closest to the patient and does not have eyes or thyroid protection.

Background: In the modern clinical practice, providing fast, mobile and high-quality bedside X-ray imaging is important for managing newborn children . Thus, the development of new devices with all these features and their clinical application are of considerable significance. Aims: Estimation of the diagnostic capabilities of a microfocal X-ray diagnostic complex for the imaging of premature newborns. Methods: The study was performed at the facilities of Almazov National Medical Research Centre. The study included X-ray examinations of 156 premature newborns using the method of microfocus radiography: 139 X-ray images of the chest, 17 X-ray images of the abdomen. The imaging was performed using the projection magnification technique with a patient positioned close to the X-ray source. Results: The microfocal X-ray images showed the necessary quality for the diagnosis of pathological changes in the chest and abdomen in infants. The patient dose estimation was based on the radiation output of the X-ray unit and the tube current-time product. For the maximum values of the tube voltage, tube current and exposure time, the effective doses did not exceed 0.02 mSv, corresponding to the negligible radiation risk category. Conclusions: Microfocal radiography allows performing informative X-ray examinations of premature newborns, especially using the projection magnification technique. The use of a microfocal X-ray diagnostic complex allows reducing patient doses, increasing the mobility and usability of the X-ray equipment. The first experience of clinical application of microfocal radiography in neonatology and pediatrics with the projection magnification of an X-ray image was found successful. The implementation of this device in pediatric clinical practice will optimize the tactics of managing premature newborns.

Background Patients with renal stones receive multiple computed tomography (CT) examinations. We investigated whether submillisievert (sub-mSv) CT for stone detection could reduce radiation dose at exposure levels comparable to kidney, ureter, and bladder (KUB) radiography. Purpose To evaluate the radiation dose exposure, diagnostic performance, and image quality of sub-mSv non-contrast CT using advanced modelled iterative reconstruction algorithm with spectral filtration for the detection of urolithiasis. Material and Methods A total of 145 consecutive patients underwent non-contrast CT using a third-generation dual-source scanner to obtain two datasets, i.e. 16.7% (sub-mSv CT, tube detector A) and 100% (standard-dose CT, combination of tube detector A and B) tube loads with spectral filtration. The performance of sub-mSv CT for the detection of stones was analyzed by two readers and compared with that of standard-dose CT. Image quality was measured subjectively and objectively. Results In total, 171 stones were detected in 79 patients. The mean effective radiation doses of sub-mSv CT was 0.3 mSv. The sensitivity and specificity values for diagnosis of stones measuring ≥3 mm was 95.1% and 100% for sub-mSv CT. The sensitivity and specificity for all stone detection was 74.9% and 97.8%, respectivey, for sub-mSv CT. The image quality was lower for sub-mSv CT than for standard-dose CT ( P < 0.01). Conclusion Sub-mSv CT can be achieved with radiation doses close to KUB radiography. Sub-mSv CT with spectral filtration can be used to detect stones measuring ≥3 mm and be used as a follow-up imaging modality as an alternative to KUB radiography.

Abstract The purpose of the research was to determine the effect of the posteroanterior (PA) patient position in lumbar spine imaging on effective dose and the absorbed organ dose. The study was performed on 100 patients that were referred to the lumbar spine radiography that were divided into two equal groups of 50. Body Mass Index, Dose Area Product (DAP), exposure index (EXI), tube time-current (mAs), image field size and the source-patient distance were acquired for each patient. The entrance surface dose (ESD), the effective dose and the absorbed organ doses were calculated. There was no statistically significant difference in the BMI and EXI between the AP and PA projection. The results showed a significant reduction of ESD by 33% and the effective dose by 53% when the PA projection was used. Furthermore, there was a 64% average reduction of the absorbed organ doses to the selected organs.

Traditional x-ray sources used today for multiple applications, such as medical imaging (computed tomography, radiography, mammography, and interventional radiology) or industrial inspection, are vacuum based electron beam devices that include several key components, such as electron emitters, electron guns/cathodes, and anodes/targets. The associated electronics for electron beam generation, focusing and control, and beam acceleration are located outside the vacuum chamber. The general topology of these tubes has been directionally unchanged for more than 100 years; however, tube design remains a long, inefficient, tedious, and complex process; blind design of experiments do not necessarily make the process more efficient. As a case study, in this paper, we introduce the differential evolution (DE), an artificial intelligence-based optimization algorithm, for the design optimization of x-ray source beam optics. Using a small-scale design problem, we demonstrate that DE can be an effective optimization method for x-ray source beam optics design.

The aim is a demonstration of a rare clinical observation of cystic ileal duplication with a complex diagnostic search of the common source of recurrent bleedings. The boy of 7 years was on the treatment at the Research Institute of Emergency Pediatric Surgery and Traumatology due to frequent recurrent gastrointestinal bleeding. There was performed a comprehensive examination, including laboratory and instrumental methods: common blood and urine test, biochemical blood tests, x-rays of the abdomen, scintigraphy, ultrasound of the abdominal organs, esophagogastroduodenoscopy, colonoscopy, video capsule endoscopic study. Results. The complex diagnostic search was performed. On the basis of the video capsule endoscopic examination and radiography of the abdominal cavity there was suspected the cystic duplication of the ileum with ulcerative defects as the source of bleeding. Upon completion of the examination and relief of post-hemorrhagic anemia there was executed the surgical treatment with resection of the changed area of the intestine and anastomosis “end to end”. The postoperative period was uneventful. Conclusion. Recurrent intestinal bleedings and bowel obstruction can be a complication of such rare malformation of the intestinal tube as the intestinal duplication. The use of modern diagnostic and surgical technology provides timely and minimally invasive treatment that leads to the rapid patient recovery, decline in overall costs and the cost of treatment.

OBJECTIVES/SPECIFIC AIMS: QuantiFERON-TB Gold In-Tube (QFT) conversion from negative to positive, is regarded as a marker of recent latent tuberculosis infection and may be predictive of incident active tuberculosis (TB) disease. However, it remains unclear how conversion is influenced by individual and environmental factors, including the infectiousness of the source case to whom the contact was exposed. We aimed to examine the effect of infectiousness of TB in the source case, as measured by presence of cavitation on chest X-ray, on the incidence of QFT conversion among close contacts of the pulmonary TB index case, after adjusting for potential confounding by contact and source case characteristics. METHODS/STUDY POPULATION: The Regional Prospective Observational Research for Tuberculosis (RePORT)-Brazil is an ongoing prospective cohort study that enrolls close contacts of culture-confirmed pulmonary TB patients and follows them for 24 months for development of active TB. Demographic, clinical, and diagnostic information are obtained at baseline and during follow-up at clinical visits and by telephone. QFT testing is performed at baseline and repeated after 6 months if the baseline QFT is negative. A positive IFN-γ value is defined as >0.35 IU/mL, as recommended by the manufacturer and the CDC, and QFT conversion is defined as a negative QFT at baseline followed by a positive QFT at 6 months. RESULTS/ANTICIPATED RESULTS: Among 260 enrolled contacts with nonpositive baseline QFT results and 6 months of follow-up, 198 (76%) were retested with QFT 6 months after enrollment. Of those retested, 26 (13%) converted to positive. Presence of any cavitation in the source case, based on chest radiography, was significantly associated with QFT-conversion (ORunadjusted=2.4, 95% CI: 1.0–5.7). Additional univariate analyses revealed that QFT conversion was associated with black and brown race (compared with white race) of the contact, current smoking and current alcohol use in the source case. After adjusting for potential confounders (age, sex, and race of the contact and current smoking of the source case), the association between source case cavitation and QFT conversion remained (ORadjusted=2.5 95% CI: 1.0–6.2). As of December 6, 2017, none of the QFT-retested contacts had developed active TB, with a median follow-up of 12.3 months (IQR: 7.1–13.1). We anticipate that ongoing enrollment and follow-up may yield cases of active TB; future analyses will provide greater precision for examining predictors of QFT-conversion and its association with incident TB. DISCUSSION/SIGNIFICANCE OF IMPACT: Our preliminary results agree with published literature suggesting the infectiousness of TB in the index case is a predictor of incident LTBI. Along with recent LTBI, immune suppression, HIV co-infection, and type 2 diabetes are considered risk factors for progression to active TB disease. Because only a small proportion of persons progress from LTBI to active TB disease, it is not appropriate to treat all persons with LTBI. Thus, more research is needed to identify groups at highest risk for QFT-conversion and incident TB disease, so these groups can be targeted for TB prevention, interventions, and facilitate a decline in TB incidence and mortality.

In the article the dose rate measurement technique of the pulsed X-ray source RAP-160-5 is presented. The examples of the dose rate spatial distribution for the different pulsed X-ray tube parameters at the different distance between the pulsed X-ray source focus and the detector are demonstrated. The recommendations for the radiation dose optimization to the objects under investigation from the different distance between the pulsed X-ray source focus and the detector are proposed.

Electronic devices such as medical instruments implanted in the human body and electronic control units installed in automobiles have a large impact on human life. The electronic circuits in these devices require highly reliable operation. Radiographic testing has recently been in strong demand as a nondestructive way to help ensure high reliability. Companies that use high-density micrometer-scale circuits or lithium-ion batteries require high speed and high magnification inspection of all parts. The authors have developed a new X-ray source supporting these requirements. The X-ray source has a sealed tube with a transmissive target on a diamond window that offers advantages over X-ray sources having a sealed tube with a reflective target. The X-ray source provides high-power-density X-ray with no anode degradation and a longer shelf life. In this paper, the authors will summarize X-ray source classification relevant to electronic device inspection and will detail X-ray source performance requirements and challenges. The paper will also elaborate on technologies employed in the X-ray source including tube design implementations for high-power-density X-ray, high resolution, and high magnification simultaneously; reduced system downtime for automated X-ray inspection; and reduced dosages utilizing quick X-ray on-and-off emission control for protection of sensitive electronic devices.

Objective. To determine whether an endotracheal tube modified by incorporation of a fiberoptic strand in the wall and connected to a light source could be safely and reliably positioned in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprastemal notch of the chest wall. Methods. All newborns in the Vanderbilt Neonatal Intensive Care Unit who were candidates for intubation by established clinical criteria, who were not already intubated, were candidates for the study. We defined optimal placement of the endotracheal tube to be one with the tip of the tube below the first thoracic vertebral body and no less than 0.5 cm above the carina or at T-4 (if the carina could not be seen on the radiograph). A light source was connected to the fiberoptic strand and the endotracheal tube positioned so that a circle of light was visible on the skin of the chest wall at the suprasternal notch. Results. In all 22 placements, the tube tip was below the larynx and above the canina. In 20 of the placements, the position was optimal between T-1 and T-4, whereas in the other 2 the tube tip was high between the larynx and the thoracic inlet. This system required that an endotracheal tube 0.5 mm smaller than usually used be utilized because of the slight increase in outer diameter due to the fiberoptic strand. Conventional suction catheters were used in this study. Conclusions. This study has shown that the illuminated endotracheal tube is a reliable device for accurate positioning in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprasternal notch.

Abstract. Early detection of breast cancer is the first step in prevention that can be done by women, therefore when one is diagnosed with breast cancer, the appropriate treatment can be performed quickly and accurately. Early diagnosis of breast cancer can be a way of mitigation in preventing breast cancer through the use of mammography. Bureau of Radiology as said by The Joint Commission on Accreditation of Hospitals (JHCA) stated that one of the responsibilities of the radiology unit is to control the quality of service which aims to minimize the radiographic image repetition factor; as well as maximizes the quality of radiographic image. Quality control tests are an effort that is needed on the mammography X-ray diagnostics tools. This is done to maintain the quality of expected output. The parameters that are included within the radiation output are the magnitude of current and the voltage of tube that are produced; therefore they remained constant and correspond to the recommended standard. Bureau of Radiological Health, as said by JHCA mentioned that to control the quality of image which will minimize the radiographic image repetition and maximizes the quality of radiographic image. Therefore the radiation output will not be dangerous later. The early stage of the quality control test on the machine was conducted by setting all the filtrations which were placed to capture the x-ray on the x-ray plane tube with minimum value. Then, ionization chamber is placed on the test subject points; right after that the distance between it to the radiation source is noted. The x-ray film is place on a film on the compression table of the patient and the distance between film and the focus point is noted. This is then exposed using a target filter Mo/Mo by setting the current as well as variation the voltage and time. The standard voltage measurements are 20-33kVp. This data is from the observations of time exposure; the output value is then noted. The above procedure is conducted from the minimum voltage to the maximum voltage. The output ray is measured for each voltage. The same procedure is conducted to the target filter Mo/RH. The results obtained are that the greater the input voltage and current will subsequently produce greater doses, therefore the exposure has exceeded the standard limit 0.1 mHy with longer exposure time. The HVL density thickness on the mammography X-ray machine determined the quality of the beam and the doses of x-ray exposure on the mammography machine. The output stability of x-ray beam exposure in the mammography machine mode Mo/Mo still fulfill the standard which is the value of 69% Keywords: Quality Control, Sinar-X, mammography, Mp/Mo, Mo/RH

Background: In conventional X-ray examinations, patients are exposed to radiation. Biological hazards from radiation of any source is expressed as effective dose, and is measured in millisieverts (mSv). The purpose of this study was to assess and calculate the effective dose values for patients undergoing posteroanterior (PA) chest, abdomen, anteroposterior (AP) pelvis, and cervical spine X-ray examinations in general hospitals of Erbil city and compare it with those of other studies. Materials and Methods: A total of 255 patients between 20-70 years of age participated in this work (85 per hospital). The patients’ characteristics included age, sex, examination type, projection posture, and exposure parameters captured by NOMEX Multimeter including tube potential and current-time product. The mean effective doses (EDs) of four different examinations (chest (PA), pelvis (AP), abdomen, and cervical spine) were measured using the Monte Carlo method and compared with those of other studies. Results: The mean EDs were calculated 1.04, 2.01, 3.12, and 3.22 mSv for chest (PA), pelvis (AP), abdomen, and cervical spine, respectively. All ED values in this study were higher than those of published studies. The aim of the study was to increase the awareness of the radiographer and patients undergoing conventional X-ray diagnostic radiology on the risk of ionizing radiation for radiological protection in Erbil hospitals. Conclusion: The mean EDs were increased by an increase in the age; this may increase the probability of cancer incidence and heritable diseases. Hence, dose optimization is required due to more probable incidence of cancer when compared to other studies.

BACKGROUND: Infants admitted to neonate intensive care units (NICUs) are placed in incubators to maintain body temperature and condition, which undergo normal radiographs and are exposed to radiation. Furthermore, different incubator structures in different hospitals exhibit varying object to image receptor distance (OID), source to image receptor distance (SID), presence of canopy, which results in variations in X-ray radiation conditions and doses absorbed by the neonatal patients. OBJECTIVE: To measure organ dose exposed to neonatal patient in different incubator settings. METHODS: A portable X-ray was performed on a neonatal patient placed in an incubator to identify disease progress, the injection path of the drug, and various factors. To minimize direct contact between neonatal patients and image receptor, radiologic technologists place the image receptor on a tray underneath the incubator and place the portable X-ray tube on top of the acrylic canopy of the incubators. SID and OID settings and value of organ dose exposed to the patient varied based on the incubator structure, and the organ absorbed dose was determined using Monte Carlo N-Particle (MCNP) simulation, PC-based Monte Carlo program (PCXMC) 2.0 simulation, and neonate phantoms. RESULTS: Evaluations of organ dose of neonatal patients in three hospitals with different incubator settings reveal that the average organ dose differs by 36% depending on change in OID and SID settings and reduces by 10% with an acrylic canopy. Therefore, owing to the presence of an acrylic canopy on the top of the incubator and the longer SID with the corresponding shorter OID, a lower dose was absorbed by organs of neonatal patient. CONCLUSION: Our results provide proof that proper incubator standard decreases organ dose to neonatal patient during continuously diagnostic X-ray procedure.

Rigid bronchoscopy is a procedure that is performed in order to directly visualize the upper and lower airway, and is carried out for either a diagnostic or therapeutic purpose. Suspected foreign body (FB) aspiration is the most common indication for performing this procedure in the pediatric age group at the Philippine Children’s Medical Center where a recent census (May 2008 to April 2009) showed that of 21 cases where rigid bronchoscopy was performed, 10 were for suspected FB aspiration. A review of 101 cases in the same institution showed that the average age of patients with FB aspiration was 2 years and the most common item aspirated was a peanut followed by the atis (sweetsop) seed and chicken bone chips. The most common inorganic foreign body was an earring and “whistle” (which broke off from a toy).1 It is more common in males probably because of their usually more active nature and is frequently found in the right mainstem bronchus, where the FB more easily lodges - being straighter, shorter and wider in diameter. FBs are life-threatening events in children that require early diagnosis and prompt successful management.2 A good history, physical examination and analysis of diagnostic tests are vital in every situation. In most cases, the child’s aspiration of the foreign object is a witnessed event 3 and this history of aspiration is the most sensitive diagnostic tool. The main symptoms include choking, prolonged cough, and dyspnea. Abnormal physical examination findings are found in 67% to 80% of cases and include unilaterally decreased breath sounds, wheezing and stridor.2, 4 Radiographic procedures may show abnormal findings in only about 68-86% of cases.4 5 The most useful radiographs requested are the chest posteroanterior (anteroposterior in infants and small children) and lateral views which may help localize the impaction site when the object aspirated is radiopaque.3 However, most inhaled FBs are radiolucent, and their presence can be suspected by obtaining inspiration and expiration views to demonstrate unilateral hyperinflation. Other suggestive features include atelectasis, pneumothorax and pneumonia. These indirect radiologic features of FB inhalation are present in 76% of cases.2, Where inspiration and expiration views cannot be obtained, as in very young children, left and right decubitus views may be helpful. 6 Fluoroscopic studies may also be obtained along with the plain radiographs, however, specificity and sensitivity are not very high.4 Virtual bronchoscopy may also be used in patients with suspected FB aspiration. Virtual bronchoscopy which uses multislice computerized tomography (MDCT) with realistic 3-dimensional reconstruction may be helpful in detecting and localizing the FB prior to any surgical procedure and thus decreasing the number of patients needing diagnostic bronchoscopies.7 Flexible fiberoptic bronchoscopy under local anesthesia and premedication may also be performed in cases of suspected FB aspiration wherein clinical and radiologic findings are not consistent with FB aspiration. When no FB is visualized, the patient is saved a rigid bronchoscopic procedure under general anesthesia.8 Flexible fiberoptic bronchoscopy is also used therapeutically to remove FBs in the bronchus, however, successful removal is more common with rigid bronchoscopy. All the necessary instruments needed for the procedure must be prepared. As much as possible 2 of each instrument are prepared: 2 bronchoscopes (one estimated from the age and size of the child and one smaller than that – just in case!), 2 suction devices (if one gets clogged up, the other one is ready) and 2 forceps. The peanut forceps is ideal, not only for peanuts but usually for other nuts as well; the alligator forceps is useful for relatively flat foreign bodies; while the “jaw type” forceps appears to be useful for everything else.9 The instruments are then tried, to check if they are in working order before commencement of anesthesia. This involves checking the transparency of the glass window plug, ensuring that the light source and the proximal prismatic light deflector are both illuminating, and trying out all the forceps and suction tips. It is best to try the instruments on an object similar to what the child aspirated.3 The surgical assistant, nurse and instruments are usually on the right (if the surgeon is right-handed) and anesthesiologist on the left. The suction and bronchoscope are then made ready. Knowledge of the anatomy of the tracheobronchial tree is imperative to be able to navigate through this area while looking for the FB. The use of optical forceps with mounted rod-lens telescopes has made the removal of airway FBs simpler, quicker and safer. These new devices have led to decreased complication rates and fewer missed or incomplete FB removals. While access to FBs located in the distal small segmental bronchi especially in very young children may be limited with the use of optical forceps,10 this can be overcome by removal of the connecting bridge to allow the optical forceps to be passed distal to the tip of the bronchoscope. An anesthesiologist familiar with the procedure must be called in. It is very important to have discussed the case and the procedure with the anesthesiologist prior to the operation to minimize confusion and promote harmony. Most anesthesiologists have become at ease with giving intravenous general anesthesia which circumvents the use of potentially noxious gases. Assisted spontaneous ventilation can avoid the need for muscle relaxation and paralysis so that the wake-up time is shortened. Intravenous general anesthesia with propofol and assisted spontaneous ventilation is currently the frequently used anesthetic technique for rigid bronchoscopy although volatile agents and gases are still used.11,12 The patient is placed supine on the operating table. A shoulder roll is not required. After induction of anesthesia, the patient is hyperventilated to 100% oxygen saturation to take full advantage of operating time.3 A topical anesthetic (lidocaine or tetracaine) is sprayed into the laryngeal area and distally into the trachea to lessen stimulus and pain, thus lowering the level of the anesthetic agent used and minimizing the possible occurrence of laryngospasm after the procedure.12 The state of dentition is inspected and a tooth guard placed over the upper teeth. Although it is possible to do bronchoscopy directly without using a laryngoscope, it is more expedient to use the laryngoscope (with the left hand) to visualize the larynx. The assistant (most likely the ORL resident but occasionally, a nurse) hands over the bronchoscope (to the right hand) without the glass window plug initially (because it may fog up or fall off) and the bronchoscope is inserted by looking through the bronchoscope as it passes through the larynx. Rotating the bronchoscope by 900 (with the axis of the lip in the anteroposterior axis of the glottis chink) is often useful for easier bronchoscopic insertion.2 Never force the bronchoscope into the larynx – if there is difficulty, reposition the laryngoscope to better visualize the larynx. Where exposure of the larynx is adequate, inability to pass the bronchoscope may be due to the bronchoscope lip hitting a vocal fold instead of entering the glottic chink. Another possibility is that the bronchoscope is too large to fit through a narrowed subglottis. The laryngoscope is removed once the bronchoscope has been inserted and the anesthesiologist connects the anesthetic tube to the standard 15-mm adapter of the bronchoscope and the glass window plug is inserted (this is again removed when the forceps is introduced or suctioning needed). A 0o telescope of the appropriate size may be inserted at this time or even during the initial insertion of the bronchoscope. The left hand is placed over the tooth guard and the thumb and index finger are used to support the bronchoscope being held in the right hand, much like a billiard cue. The left thumb lifts the bronchoscope off the tooth guard to enable the bronchoscope to be advanced without resistance. The bronchoscope is advanced slowly, always ensuring that the lumen is clearly in view, and suctioning whenever needed. Once the carina is seen, the main bronchus, where the FB is likely to be located, is then entered. Turn the head to the left to enable passage into the right main bronchus, and then to the right to enter the left main bronchus. Some degree of neck flexion can also be helpful in aligning the main bronchus. The bronchoscope is advanced until it is as near as possible to the FB to allow accurate suction of secretions so that the surgeon can determine how best to orient the forceps during application. The bronchoscope is then slightly withdrawn to allow the forceps to be freely inserted beyond the bronchoscope. The forceps are opened as widely as possible as this stretches the airway walls and allows the foreign body to fall into the jaws of the forceps which is then firmly grasped. Care must be taken not to push the FB further down the airway. If the FB fits through the bronchoscope, then it is pulled right through without removing the bronchoscope. However, if the FB does not fit through the bronchoscope, then the bronchoscope has to be withdrawn with the FB trailing behind held by the forceps. It is important to keep your eyes (and hands) on the bronchoscope and forceps at all times. The FB may become caught in the larynx or dropped into the trachea, causing complete airway obstruction. This possibility should always be anticipated and equipment be able to deal with this needs to be readily at hand. To prevent the FB being lost at the laryngeal inlet, the bevel of the bronchoscope is moved around over the FB by rotating the bronchoscope 900 and the bronchoscope is slightly tilted down at this area. A firm grip on the forceps with the FB must be maintained and hopefully, it is still there when the forceps is removed from the oral cavity. If the FB has been removed from the tracheo-broncial tree, but is not found in the forceps, the naso-oro-hypo pharynx should be checked in addition to a repeat bronchoscopy. All throughout the procedure, it is imperative to listen to the sound of the oxygen saturation monitor for signs of desaturation and to inquire from the anesthesiologist regarding the condition of the patient. If desaturation occurs, the bronchoscope is moved back out of the bronchus and into the trachea to allow the anestheshiologist to ventilate the patient through the bronchoscope adaptor. If this is due to a large FB that slipped while in the trachea, then, the FB must be removed right away or pushed back into the bronchus to regain the airway. Once the FB is removed , a second bronchoscopic examination is done to check for any pooling of secretions or blood that may need to be suctioned or for any remnant of the FB- which may have accidentally separated from the bigger piece- that has to be retrieved. Small pieces can often be removed by suctioning. Rarely, a tracheostomy may have to be performed for a FB that, during extraction, will not fit through the laryngeal inlet. Tracheotomy is performed while the bronchoscope is in place and with the forceps grasping the FB. The FB is extracted through the tracheostoma. Afterwards, tracheostoma is closed with sutures and regular wound care is initiated. If the procedure took less that an hour with minimal trauma, then the child is assisted with ventilation until he/she recovers full spontaneous respiration. A dose ofteroids may also be given (I.V. Dexamethasone, 1.0 to 1.5 mg/kg; maximum, 20 mg). The patient is brought to the post-anesthesia room and observed. Delayed diagnosis and intervention (24 hours or more) were found to be related to higher complication rates such as recurrent or chronic pulmonary infections and prolonged hospital stay. 13 Thus the need for early diagnosis and treatment of cases with suspected FB aspiration.

Background/Objectives: The purpose of this study is to improve the image quality and minimize the exposure dose that the patient receives by changing the source to image distance (SID) during the lateral examination of sternum in general examinations. Methods/Statistical analysis: The study used digital radiography (DR) system and manikin chest phantom. To describe the sternum lateral view, the phantom was examined in the true lateral position. The examination parameters were adjusted to 75, 85, 95 kVp of tube voltage and 11, 16, 20, 25, 32, 40, 50 mAs of tube current, 130, 180cm of SID. As for the filter, the study used Non-filter, 1 mmAl filter, 1 mmAl + 0.1mmCu composite filter. For dose assessment, the study measured entrance surface dose (ESD) and dose area product (DAP) for each setting, and calculated signal to noise ratio (SNR) and contrast to noise ratio (CNR) for image quality assessment. Findings: As the result, based on proper exposure index (EI) value, 180cm SID and 85 kVp, 25 mAs, non-filter setting, the ESD was 0.91 mGy and DAP was 88.2 Gycm2.

Abstract The aim of the study was to determine the influence of body mass index (BMI) on Dose-Area Product (DAP) and effective dose (ED) in overweight and obese patients. We also wanted to determine the typical dose values as well as suggest adjustments of clinical practice for overweight and obese patients. In this study 597 patients referred for imaging of the chest in PA and lateral projection, lumbar spine AP and lateral projection, imaging of the pelvis, knee in AP and lateral projection, and shoulder in AP projection were considered. For each examination, the image field size, tube voltage, mAs product, source-to-image receptor distance and values of DAP were collected. Based on BMI patients were divided into three groups (normal weight, overweight and obese). At the end, PCXMC 2.0 software was used to calculate the effective dose. The study showed a statistically significant DAP and ED increase in overweight and obese patients by 28.9% up to 275.4% in the case of DAP and an increase of ED from 11.0% to 241.9% in all mentioned examinations except knee and shoulder imaging. Typical DAP values ranged from 2.2 to 54.8 µGym2 for normal weight patients, from 2.2 to 87.6 µGym2 for overweight patients, and from 2.2 to 172.5 µGym2 for obese patients. Spearman’s correlation coefficient showed from very weak to very strong correlations when comparing BMI and DAP as well as comparing BMI and ED. A strong and very strong correlation was found in case of the examinations of the torso (except for the comparison of BMI and ED in case of lateral lumbar spine projection).

AbstractIntroduction:Cholangiocarcinoma (CCA) or klatskin’s tumour involves malignant tumours at the liver hilum’s biliary confluence. Incidence of CCA results in unresectable tumours that require appropriate therapy to improve quality of life. The liver is considered as the most frequent site of tumour recurrence. Promising results of long-term survival have been established with computed tomography-guided high-dose-rate brachytherapy.Materials and methods:Intraluminal brachytherapy (ILBT) is performed through the percutaneous transhapatic bile duct drain tube (PTBD). The passage of the brachytherapy guide tube through the bile duct is more complex compared with oesophageal/endobronchial application.Results/discussion:It results in a recoiled view of the tube in the abdominal region of the computed tomography (CT) scan. Owing to inherent artefacts induced by metal stents in CT scans, intersected view is possible between the ILBT guide tube and the intra-hepatic drain tube. It would mislead the planner to track wrong passage that could result in fatal error.Conclusion:In this case study, we contoured the ILBT guide tube by cross-verifying its position with a digitally reconstructed radiograph (DRR) before catheter tracking. Thus, it ensures precise simulation of source dwell positions, thereby avoiding high-dose delivery to nearby vital organs such as intestines, liver hilum and blood vessels.

AbstractRapid and accurate assessment of endotracheal tube (ETT) location is essential in the intensive care unit (ICU) setting, where timely identification of a mispositioned support device may prevent significant patient morbidity and mortality. This study proposes a series of deep learning-based algorithms which together iteratively identify and localize the position of an ETT relative to the carina on chest radiographs. Using the open-source MIMIC Chest X-Ray (MIMIC-CXR) dataset, a total of 16,000 patients were identified (8000 patients with an ETT and 8000 patients without an ETT). Three different convolutional neural network (CNN) algorithms were created. First, a regression loss function CNN was trained to estimate the coordinate location of the carina, which was then used to crop the original radiograph to the distal trachea and proximal bronchi. Second, a classifier CNN was trained using the cropped inputs to determine the presence or absence of an ETT. Finally, for radiographs containing an ETT, a third regression CNN was trained to both refine the coordinate location of the carina and identify the location of the distal ETT tip. Model accuracy was assessed by comparing the absolute distance of prediction and ground-truth coordinates as well as CNN predictions relative to measurements documented in original radiologic reports. Upon five-fold cross validation, binary classification for the presence or absence of ETT demonstrated an accuracy, sensitivity, specificity, PPV, NPV, and AUC of 97.14%, 97.37%, 96.89%, 97.12%, 97.15%, and 99.58% respectively. CNN predicted coordinate location of the carina, and distal ETT tip was estimated within a median error of 0.46 cm and 0.60 cm from ground-truth annotations respectively. Overall final CNN assessment of distance between the carina and distal ETT tip was predicted within a median error of 0.60 cm from manual ground-truth annotations, and a median error of 0.66 cm from measurements documented in the original radiology reports. A serial cascaded CNN approach demonstrates high accuracy for both identification and localization of ETT tip and carina on chest radiographs. High performance of the proposed multi-step strategy is in part related to iterative refinement of coordinate localization as well as explicit image cropping which focuses algorithm attention to key anatomic regions of interest.

Objectives: To perform a dose assessment of radiation received to the surgeon’s gonads when performing upper limb fluoroscopy-guided procedures when the C-arm may be positioned in between the surgeon’s legs. Methods: A calibrated MDH-Radcal 2025 electrometer was used to read the radiation dose for a single exposure and a 5-s screening radiograph with the C-arm firing up and down. These were performed with and without a lead gown positioned over the ionisation chamber where it would ordinarily lie over gonads during surgery. Results: With the tube firing down and lead apron in place the single exposure (SE) recorded<0.01 uSv and screening exposure (SC) recorded 0.01 uSv. With the tube firing up, with lead the SE recorded 0.09 uSv and the SC 0.54 uSv. In the same situation without lead, the recordings were 0.13 uSv SE and 0. 65 uSv SC. Conclusions: With the X-ray tube firing up, there is a measurable radiation dose to the area where the surgeons’ gonads lie. The standard lead apron does not provide shielding of the gonads for a surgeon sitting down performing the operation with the tube firing up since the principal source of the radiation is below the edge of the apron and thus scatters up into the unprotected groin. Advances in knowledge: Fluoroscopy with conventional C-arm in upper limb procedures can cause scatter irradiation to gonads. The X-ray beam should always be fired from top to bottom otherwise large doses can be emitted and the lead gown is less protective.

Abstract Introduction Bernese periacetabular osteotomy is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection with residual dysplasia or femoroacetabular impingement. Thus, we wanted to find a simple method to control the effect of correction in the sagittal and coronal plane. Method The acetabular coordinates are shown by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the acetabular fragment with two Schanz screws. This method enables the isolated acetabular reorientation in the coronal, sagittal, and transverse plane. In a sawbone pelvis model, the acetabular rim is marked with a copper wire and a silicon adherent. To show the radiographic effect on acetabular parameters and the rim position, we visualized correction in the coronal and sagittal plane under fluoroscopic control. Results Lateral rotation of the acetabular fragment had the highest impact on radiographic lateral coverage of the femoral head. But also ventral coverage increased during isolated lateral rotation. Anterior rotation showed almost no effect on lateral coverage and just a little effect on ventral coverage but caused severe total acetabular retroversion. Conclusion Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and under-correction. Isolated lateral rotation of the acetabular fragment should be the predominant direction of correction during periacetabular osteotomy. Ambitious anterior correction may be the main source for severe acetabular retroversion following periacetabular osteotomy.