scholarly journals 278 The Acute Spine Fracture in the Emergency Department; a Retrospective Review

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Owen Thorpe ◽  
Avril Beirne ◽  
Paul Fox ◽  
Aoife Nic Uidhir ◽  
Frances Dockery
Keyword(s):  
Best Practice ◽  
Osteoporosis Treatment ◽  
High Risk Group ◽  
Consecutive Series ◽  
Spine Fractures ◽  
Acute Management ◽  
X Rays ◽  
Available N ◽  
Radiology Reports ◽  
Fracture Diagnosis

Abstract Background As to who should manage osteoporotic spine fractures presenting to Emergency departments (ED) is sometimes debated. We sought to review practice regarding their management in our institution that might inform a clinical pathway. Methods We conducted a search of radiology reports for a consecutive series of thoracic or lumbar spine x-rays ordered by ED team only, i.e. a series of patients whose presenting complaint was a suspected acute fracture. We narrowed search to include terms ‘compression’ or ‘wedge’ or ‘end-plate’. Results Over 7 months, there were 1,505 such reports; narrowed search and excluding duplicates yielded 168 patients of whom 84 had a fracture. We looked at the acute management of those >50yrs, excluding one metastatic fracture leaving n=64. Of these, 65% occurred following a fall, 14% on twisting/bending/coughing, 14% spontaneous, 7% unclear onset. ED first consulted orthopaedics for 10 cases, neurosurgeons for 2, physicians for 18. A total of 21 were discharged from ED (5 having speciality review pre-discharge). A further 11 were sent home from ED with fracture diagnosis made only when x-ray subsequently reported. Of those admitted, 28 went to physicians with consult to surgeons in 39%, 2 went to orthopaedic surgery, 2 to other specialists. Admission was complicated by pressure ulcer in 13% (4/32), pneumonia in 13%. Overall 24/64 (38%) went on to have MRI/CT (mainly admitted cases). At least 12 were managed with a brace (all records not available). N=7 (11%) had later vertebroplasty. More than half had no documented osteoporosis treatment plans nor GP instruction to address. Conclusion Care of spine fractures presenting acutely varies; a high proportion managed by ED solely. Whether outcomes vary as a result is not answered by this audit but there is a need for a pathway to inform best practice. Osteoporosis is inadequately-addressed in this high risk group, highlighting need for fracture liaison services in post-acute management.

OUTCOME PREDICTORS AND SPECTRUM OF TREATMENT ELIGIBILITY WITH PROSPECTIVE PROTOCOLIZED MANAGEMENT OF INTRACEREBRAL HEMORRHAGE

Neurosurgery ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. 436-446 ◽  
Author(s):  
Jennifer Jaffe ◽  
Lora AlKhawam ◽  
Hongyan Du ◽  
Kristen Tobin ◽  
Judith O'Leary ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Best Practice ◽  
Initial Assessment ◽  
Consecutive Series ◽  
Best Practice Guidelines ◽  
Management Protocol ◽  
Scale Scores ◽  
Contemporary Management ◽  
Risk Predictors

Abstract OBJECTIVE Risk predictors, spectrum of treatment eligibility, and range of expected outcomes have not been validated in consecutive series including all cases of intracerebral hemorrhage (ICH) subjected to a prospective management protocol based on current guidelines. METHODS Eighty-six cases of ICH were prospectively identified in conjunction with screening for a clinical trial during an 18-month period. All patients were subjected to protocolized management based on published “best practice” guidelines for ICH. Medical records were reviewed by trained researchers, and outcomes were assessed at various time points including latest follow-up (range, 0–24 months; mean, 3.97 months). Initial assessment parameters, treatment eligibility, and outcomes were based on standardized criteria. RESULTS In accordance with past literature, mortality and functional outcomes were significantly worse in older patients, those with a larger ICH volume, and worse Glasgow Coma Scale scores, in univariate and multivariate models. The presence and severity of associated intraventricular hemorrhage also correlated with mortality and outcome. Significantly lower mortality (P = 0.024) and better functional outcomes (P = 0.018) were achieved at 30 days in patients with an ICH volume of less than 30 cm3 in this series than in previously published community-based historical controls without protocolized care. A tight correspondence between treatment eligibility and treatment administered was found. CONCLUSION Previous estimates of poorer outcome in patients with ICH might not apply to contemporary management protocols, especially in patients with a smaller ICH volume. Outcome ranges in various risk categories and modeling of treatment eligibility will help project more realistic prognostication and assist with the design of future trials.

scholarly journals Evaluating Diagnostic Content of AI-Generated Radiology Reports of Chest X-rays

2021 ◽  
pp. 102075
Author(s):  
Zaheer Babar ◽  
Twan van Laarhoven ◽  
Fabio Massimo Zanzotto ◽  
Elena Marchiori
Keyword(s):  
X Rays ◽  
Radiology Reports

scholarly journals The Effect of Image Resolution on Automated Classification of Chest X-rays

2021 ◽  
Author(s):  
Md Inzamam Ul Haque ◽  
Abhishek K Dubey ◽  
Jacob D Hinkle
Keyword(s):  
High Resolution ◽  
Automated Analysis ◽  
Image Resolution ◽  
Free Text ◽  
X Rays ◽  
Training Time ◽  
X Ray ◽  
Radiology Reports ◽  
Chest X Ray ◽  
High Resolution Images

Deep learning models have received much attention lately for their ability to achieve expert-level performance on the accurate automated analysis of chest X-rays. Although publicly available chest X-ray datasets include high resolution images, most models are trained on reduced size images due to limitations on GPU memory and training time. As compute capability continues to advance, it will become feasible to train large convolutional neural networks on high-resolution images. This study is based on the publicly available MIMIC-CXR-JPG dataset, comprising 377,110 high resolution chest X-ray images, and provided with 14 labels to the corresponding free-text radiology reports. We find, interestingly, that tasks that require a large receptive field are better suited to downscaled input images, and we verify this qualitatively by inspecting effective receptive fields and class activation maps of trained models. Finally, we show that stacking an ensemble across resolutions outperforms each individual learner at all input resolutions while providing interpretable scale weights, suggesting that multi-scale features are crucially important to information extraction from high-resolution chest X-rays.

Worsening bone scan in the evaluation of antitumor response during hormonal therapy of breast cancer.

1995 ◽  
Vol 13 (5) ◽  
pp. 1123-1128 ◽  
Author(s):  
C L Vogel ◽  
J Schoenfelder ◽  
I Shemano ◽  
D F Hayes ◽  
R A Gams
Keyword(s):  
Breast Cancer ◽  
Disease Progression ◽  
Retrospective Analysis ◽  
Hormonal Therapy ◽  
Bone Scan ◽  
Large Scale ◽  
Response To Therapy ◽  
X Rays ◽  
Cancer Trial ◽  
Radiology Reports

PURPOSE Scintigraphic flare in association with response to therapy has been well described in the medical literature. During the course of a recent breast cancer trial, it became apparent that several patients with worsening bone scan but no other clinical evidence of disease progression might have potentially benefited from continued therapy, but had therapy discontinued. A retrospective analysis of this issue was performed to assess the magnitude and scope of this problem. MATERIALS AND METHODS A total of 648 patients with hormone receptor-positive or unknown advanced breast cancer were treated as part of a large-scale trial of first-line hormonal therapy. Patients were assessed for response to therapy, including response duration, progression-free interval (PFI), overall survival, and quality of life. The retrospective analysis presented here was performed to assess whether patients with a possible scintigraphic flare within the first 16 weeks of therapy might have had therapy discontinued prematurely due to a worsening bone scan attributable to tumor flare, rather than due to disease progression. RESULTS Analysis of the hormonal trial showed that of 376 assessable patients 108 (29%) with bone disease had a possible scintigraphic flare by week 8 or 16 of the trial, based on data on the case report forms and radiology reports (bone scans and x-rays). Of these, 69 patients (64%) were continued on study therapy, which resulted in clinical benefit in 50 (72%) of those patients. In contrast, 39 patients (36%) with possible scintigraphic flare were removed from the trial. CONCLUSION We conclude that changes in bone scintigraphy that mimic progressive disease early in the course of hormonal treatment of patients with breast cancer metastatic to bone may represent scintigraphic flare associated with response. Thus, clinicians must be cognizant of the phenomenon of scintigraphic flare to avoid premature discontinuation of a potentially beneficial treatment.

Large Iliac Arteries: A High-Risk Group for Endovascular Aortic Aneurysm Repair

2007 ◽  
Vol 14 (5) ◽  
pp. 625-629 ◽  
Author(s):  
Ciaran O. McDonnell ◽  
James B. Semmens ◽  
Yvonne B. Allen ◽  
Shirley J. Jansen ◽  
D. Mark Brooks ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Iliac Artery ◽  
High Risk Group ◽  
Consecutive Series ◽  
Type Ii ◽  
Secondary Intervention ◽  
Iliac Arteries ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Purpose: To examine if the presence of large iliac arteries is a potential risk factor for the development of a type Ib endoleak (iliac sealing zone) or need for iliac artery—related secondary intervention in patients undergoing endovascular abdominal aortic aneurysm repair. Methods: The medical notes and all preoperative and postoperative plain abdominal radiographs and computer tomographic scans were reviewed for a consecutive series of 100 patients (89 men; mean age 75 years, range 56–91) with large iliac arteries (mean 19.7 mm, range 16–22) who had Zenith endovascular stent-grafts inserted for management of aortoiliac aneurysmal disease from January 1999 until September 2002. Endpoints were all-cause mortality, aneurysm-related death, endoleak, secondary intervention, secondary interventions, and stent-graft migration. Results: Mean follow-up was 30.1±8.3 months; at the last follow-up, 30% of patients were dead, 3% were aneurysm-related. Seven (7%) patients developed a type Ib endoleak, with the remainder being type II (29%), type Ia (2%), type III (1%), and type V (endotension, 1%). Eight (27.5%) type II endoleaks persisted, with the remainder closing spontaneously with sac shrinkage. The iliac artery—related secondary intervention rate was 10%, and the overall secondary intervention rate was 16%. Conclusion: Iliac arteries between 16 and 22 mm in diameter may be treated with a cuff to the iliac limb with an expectation of 90% efficacy. Surveillance is required, with a high index of suspicion for type 1b endoleaks. Early secondary iliac intervention with extension to the external iliac artery is recommended if there is an increase in sac size after 6 months.

Development of a System that Generates Structured Reports for Chest X-ray Radiography

2010 ◽  
Vol 49 (04) ◽  
pp. 360-370 ◽  
Author(s):  
Y. Matsumura ◽  
N. Mihara ◽  
Y. Kawakami ◽  
K. Sasai ◽  
H. Takeda ◽  
...  
Keyword(s):  
Narrative Form ◽  
Free Text ◽  
X Rays ◽  
Sentence Structure ◽  
X Ray ◽  
Radiology Reports ◽  
Chest X Ray ◽  
Structured Reports ◽  
Description Framework ◽  
Resource Description

Summary Objectives: Radiology reports are typically made in narrative form; this is a barrier to the implementation of advanced applications for data analysis or a decision support. We developed a system that generates structured reports for chest x-ray radiography. Methods: Based on analyzing existing reports, we determined the fundamental sentence structure of findings as compositions of procedure, region, finding, and diagnosis. We categorized the observation objects into lung, mediastinum, bone, soft tissue, and pleura and chest wall. The terms of region, finding, and diagnosis were associated with each other. We expressed the terms and the relations between the terms using a resource description framework (RDF) and developed a reporting system based on it. The system shows a list of terms in each category, and modifiers can be entered using templates that are linked to each term. This system guides users to select terms by highlighting associated terms. Fifty chest x-rays with abnormal findings were interpreted by five radiologists and reports were made either by the system or by the free-text method. Results: The system decreased the time needed to make a report by 12.5% compared with the free-text method, and the sentences generated by the system were well concordant with those made by free-text method (F-measure = 90%). The results of the questionnaire showed that our system is applicable to radiology reports of chest x-rays in daily clinical practice. Conclusions: The method of generating structured reports for chest x-rays was feasible, because it generated almost concordant reports in shorter time compared with the free-text method.

scholarly journals An Improved VGG16 Model for Pneumonia Image Classification

2021 ◽  
Vol 11 (23) ◽  
pp. 11185
Author(s):  
Zhi-Peng Jiang ◽  
Yi-Yang Liu ◽  
Zhen-En Shao ◽  
Ko-Wei Huang
Keyword(s):  
Neural Networks ◽  
Convolutional Neural Networks ◽  
Image Recognition ◽  
Medical Image ◽  
Best Practice ◽  
Data Augmentation ◽  
X Rays ◽  
Neural Network Models ◽  
X Ray ◽  
Medical Image Recognition

Image recognition has been applied to many fields, but it is relatively rarely applied to medical images. Recent significant deep learning progress for image recognition has raised strong research interest in medical image recognition. First of all, we found the prediction result using the VGG16 model on failed pneumonia X-ray images. Thus, this paper proposes IVGG13 (Improved Visual Geometry Group-13), a modified VGG16 model for classification pneumonia X-rays images. Open-source thoracic X-ray images acquired from the Kaggle platform were employed for pneumonia recognition, but only a few data were obtained, and datasets were unbalanced after classification, either of which can result in extremely poor recognition from trained neural network models. Therefore, we applied augmentation pre-processing to compensate for low data volume and poorly balanced datasets. The original datasets without data augmentation were trained using the proposed and some well-known convolutional neural networks, such as LeNet AlexNet, GoogLeNet and VGG16. In the experimental results, the recognition rates and other evaluation criteria, such as precision, recall and f-measure, were evaluated for each model. This process was repeated for augmented and balanced datasets, with greatly improved metrics such as precision, recall and F1-measure. The proposed IVGG13 model produced superior outcomes with the F1-measure compared with the current best practice convolutional neural networks for medical image recognition, confirming data augmentation effectively improved model accuracy.

Age Determination of Unaccompanied Asylum Seeking Minors in the European Union: A Health Law Perspective

2011 ◽  
Vol 18 (1) ◽  
pp. 11-25 ◽  
Author(s):  
Henriette D.C. Roscam Abbing
Keyword(s):  
European Union ◽  
Best Practice ◽  
Age Determination ◽  
Specific Treatment ◽  
X Rays ◽  
The European Union ◽  
Best Interest ◽  
Eu Member States ◽  
Best Practice Guidelines ◽  
Common European Asylum System

AbstractIn the European Union, unaccompanied asylum seekers below 18 years of age are entitled to specific treatment. Age assessment practices to verify the age-statement by the asylum seeker differ between EU Member States. Medical methods in use raise questions about accuracy, reliability and safety. The medical, legal and ethical acceptability of invasive methods (notably X-rays) in particular is controversial. Human rights are at stake. The lack of common practices results in different levels of protection (discrimination). The absence of standardisation is an obstacle for the functioning of the Common European Asylum System. EU Best Practice Guidelines should remedy the situation; such guidelines should reflect the best interest of the child.

Radiographic Diagnosis of Ankle Fractures: Are Three Views Necessary?

1994 ◽  
Vol 15 (4) ◽  
pp. 172-174 ◽  
Author(s):  
C. Thomas Vangsness ◽  
Vincent Carter ◽  
Timothy Hunt ◽  
Rodger Kerr ◽  
Edward Newton
Keyword(s):  
Emergency Room ◽  
Ankle Fracture ◽  
Cost Savings ◽  
Ankle Fractures ◽  
Substantial Decrease ◽  
X Rays ◽  
Ordered Sets ◽  
Radiographic Diagnosis ◽  
Fracture Diagnosis ◽  
Musculoskeletal Radiologist

One hundred and twenty-three sets of emergency room ankle x-rays (anteroposterior lateral and mortise) were retrospectively reviewed to determine whether all three views were necessary to diagnose the presence of an ankle fracture. Four physicians (two orthopaedic surgeons, one musculoskeletal radiologist, and one emergency room physician) reviewed all randomly ordered sets of films twice—once with all three views and once with only the lateral and mortise views. The overall accuracy of two views was within the 95% expected threshold of accuracy using three views. The lateral and mortise views alone appear sufficient for ankle fracture diagnosis, and imply a substantial decrease in radiation and cost savings to the patient.

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